Method for in vitro diagnosing and prognosing of triple negative breast cancer recurrence

ABSTRACT

The present invention is in the technical field of breast cancer management, and more particularly relates to the diagnosis and/or prognosing of triple-negative breast cancer (TNBC). The invention is more particularly based on the finding that specific biomarkers are abberantly expressed in patients suffering from a triple-negative breast cancer recurrence, and are highly related to the aggressiveness of this disease, and thus to survival of said patient.

RELATED APPLICATIONS

This application is a National Stage Application under 35 U.S.C. 371 of co-pending PCT application PCT/EP2014/075424, filed Nov. 24, 2014 and EP application no. 13306603.5, filed Nov. 22, 2013 each of which are hereby incorporated by reference in their entireties.

INTRODUCTION

The present invention is in the technical field of breast cancer management, and more particularly relates to the diagnosis and/or prognosing of triple-negative breast cancer (TNBC). The invention is more particularly based on the finding that specific biomarkers are abberantly expressed in patients suffering from a triple-negative breast cancer recurrence, and are highly related to the aggressiveness of this disease, and thus to survival of said patient.

With over 1.3 million cases of invasive breast cancers diagnosed annually, and more than 450,000 deaths reported per year, breast cancer is the most common malignancy diagnosed in women and one of the leading causes of cancer-related death in females.

Breast cancer represents a heterogeneous disease, as it encompasses a plethora of tumor subtypes which not only have distinct morphological features but also clinical behaviors. These subtypes have thus different implications in prognosis and response to therapy. Determination of hormone receptor status (estrogen (ER) and progesterone receptor (PR)) has become standard practice in the management of invasive breast cancers: ER positivity can predict response to endocrine therapy such as anti-estrogen administration or ovarian suppression, while human epithelial growth factor receptor 2 (HER2, c-erbB-2) positivity is useful for selecting targeted therapy with the monoclonal antibody against HER2.

Despite the decreased incidence and mortality linked to this pathology due to screening and improved therapy, breast cancer remains nevertheless a major cause of deaths. It has thus become crucial to diagnose more accurately breast cancer subtypes, and select appropriate treatments, not only for the patients, but also for health economic reasons.

Among breast cancer subtypes, triple-negative breast cancer (TNBC) is responsible for a relatively large proportion of deaths, due notably to its generally aggressive clinical outcome. Triple-negative breast cancer is defined by a lack of expression of estrogen, progesterone, and HER2/neu receptors, which accounts for about 10 to 15% of all breast cancers. The term “triple-negative breast cancer” has been described for the first time in 2005 (Brenton et al., 2005), and has since appeared in over a 1000 publications. While it is frequently presumed to affect predominantly young women (i.e. below 50 years old), its distribution is actually similar in all age groups (Hudis et al., 2011). This cancer subtype is usually more frequent in African-American women, present as interval cancers, highly chemo-sensitive, and shows a weak association between tumor size and lymph node metastases. Most importantly, it is, as mentioned above, associated with an aggressive phenotype, and has generally a poor outcome compared to other breast cancer subtypes. Unfortunately, due to its negativity for the three molecular markers ER, PR, and HER2/neu, triple-negative breast cancer is unresponsive to usual endocrine therapy or therapy targeted to human epidermal growth factor receptor type 2 (HER2). In addition, triple-negative breast cancer exhibits a very particular relapse pattern that differs from hormone-positive breast cancers, as about 30% of patient relapse in the first 3 to 5 years. This risk of relapse nevertheless decreases after about 5 years from the initial diagnosis.

Due to the absence of specific treatment guidelines for patients affected by this particular cancer, triple-negative breast cancers are nowadays managed with standard adjuvant chemotherapy. Such treatment is however less effective than for other breast cancer subtypes and remains associated with a high rate of local and systemic relapse. It is therefore critical to identify relapsing patients as early as possible, in order to adapt accordingly their treatment.

Most studies described in the literature were conducted to identify biomarkers characterizing triple-negative breast cancer, without discriminating relapsing from non-relapsing patients. Besides, these studies were mainly focused on genotypic-phenotypic correlations, such as genetic polymorphisms or gene expression variations, but not on the actual functional entities, proteins, that are differentially expressed in breast cancer cells. However, the behavior of these functional entities can not be predicted from their encoding genes. Once transcribed, a protein expression may indeed still be regulated at the translation level, and corresponding proteins can be subjected to posttranslational modifications, varying half-lives, and compartmentalization.

Given that the diagnostic and prognostic of triple-negative breast cancer and targeted therapy are today ill-defined, there is an urgent need to identify and characterize reliable biomarkers allowing to accurately identify the different subsets of TNBC patients, especially those developing a local or distant cancer recurrence, in order to design and adapt accordingly their therapy.

This need is addressed by the present invention, which reports herein the results of an investigation conducted on a large cohort of relapsing and non-relapsing triple-negative breast cancer patients, by a quantitative proteomic approach using iTRAQ labeling, peptide OFFGEL Fractionation and mass spectrometry analysis (Ernoult et al., 2008 and 2010). By contrast to genomic biomarkers, proteomic biomarkers are indeed particularly advantageous as they are more reflective of a tumor microenvironment and can undergo cancer specific posttranslational modifications. To the best of Applicant's knowledge, this is the first study investigating proteomic biomarkers in a comprehensive panel of breast cancer patients to diagnose and prognose TNBC recurrence.

By combining both a multivariate and an univariate analysis, the inventors have identified key biomarkers of triple-negative breast cancer recurrence and non-recurrence. In particular, the inventors have identified, on one hand, Desmoplakin, Rho GTPase-activating protein 1, Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate dehydroge-nase [NADP], Keratin type I cytoskeletal 19, Keratin type I cytoskeletal 8, Dihydropyrimidinase-related protein 3, and/or Thrombospondin-1 as biomarkers associated with TNBC recurrence and a poor clinical outcome, and, on the other hand, Hexokinase-1, 10 kDa heat shock protein, Ig gamma-1 chain C region, SAM domain and HD domain-containing protein 1, and/or Tryptophanyl-tRNA synthetase as biomarkers associated with TNBC non-recurrence and a good clinical outcome.

All the biomarkers disclosed herein can thus be used to monitor disease progression or regression, to assess the susceptibility or prediction of response to treatment, but also to evaluate the efficacy of a treatment. They can also be used as therapeutic targets to design novel drugs.

Therefore, based on the findings disclosed herein, the present invention provides for the first time accurate and reliable diagnostic, prognostic and therapeutic methods for triple-negative breast cancer recurrence, which are based, at least in part, on determination of the expression level of the above-mentioned biomarkers. The invention further provides a screening method for identifying drugs, a method for determining a drug-responding or non-responding phenotype, as well as a method for designing or adapting a treatment regimen. Kits and protein microarrays for carrying out the methods of the invention are also provided herein.

DETAILED DESCRIPTION OF THE INVENTION

Unless stated otherwise, scientific and technical terms used in connection with the present invention shall have the meanings that are commonly understood by those of ordinary skill in the art. Further, unless otherwise required by context, nomenclatures used herein, and techniques of molecular biology and cell culture are those well-known and commonly used in the art.

Nevertheless, with respect to the use of different terms throughout the current specification, the following definitions more particularly apply.

According to the different aspects and embodiments of the invention, the term “comprising” or “containing” means the inclusion of the referent and does not exclude the presence of any other element. By contrast to the term “comprising”, the term “consisting of” means the sole inclusion of the referent and thus excludes the presence of any other element.

By “triple-negative breast cancer” or “TNBC”, it is meant herein, as indicated above, any breast cancer that does not express the estrogen receptor (ER), the progesterone receptor (PR) and Her2/neu (HER2). A triple-negative breast cancer can thus be alternatively referred as an estrogen receptor negative (ER−), progesterone receptor negative (PR−) and Her2/neu negative (HER2−) breast cancer. Triple-negative breast cancer (TNBC) encompasses several common histologic subtypes, including notably medullary, metaplastic, secretory, myoepithelial and adenoid cystic carcinomas, as well as less common histologic subtypes such as apocrine carcinoma, pleomorphic lobular carcinoma, and duct-lobular cancer. Further information about triple-negative breast cancer (TNBC) may be found in Rakha et al. (2008).

By “recurrence”, “recurring”, “relapse or “relapsing”, it is meant herein, in the context of potential clinical outcomes of cancer and as defined by the National Cancer Institute, that the cancer has recurred (come back), usually after a period of time during which the cancer could not be detected. A recurring cancer may refer to a cancer that comes back to the same place as the original (primary) tumor or to another place in the body (also known as metastasis).

By contrast, the term “non-recurrence”, “non-relapse”, “absence of recurrence”, “absence of relapse”, means that the cancer has not recurred (i.e. not come back), usually after a period of time during which the cancer could not be detected.

The term “subject” or “patient” is used herein to describe any member of the animal kingdom, preferably a human being, more preferably a woman.

The term “diagnosing” or “diagnosis”, as used in the context of the present invention, include the act or process of identifying the existence (or non-existence) and/or type of disease from which an individual may be suffering.

The term “prognosis”, “prognosing” or “clinical outcome” as used herein refers to the likely outcome or course of a disease; the chance of recovery or non-recovery. A prognosis may indicate whether a cancer patient will likely have a cancer-attributable death or progression, and/or a short-term or long-term survival. A clinical outcome can be assessed for example in the context of an individual's outcome relative to an outcome of a population of patients having a comparable clinical diagnosis, using various endpoints well-known in the art, such as Overall Survival (OS), Disease-Free Survival (DFS), Hazard Ratios (HR) and the like. Such parameters are well-known by the skilled person, who may refer to the definitions provided by the National Cancer Institute.

The term “positive clinical outcome” or “good prognosis” means a desired clinical outcome. In the context of the present invention, a positive clinical outcome may be an expectation or low probability of TNBC-attributable death or progression. Preferably, a positive clinical outcome means that said subject has a risk of TNBC-attributable death or progression inferior to 25%, within 5 years from the initial diagnosis of triple-negative breast cancer.

By contrast, the terms “negative clinical outcome” or “poor prognosis” are used herein interchangeably to mean an undesired clinical outcome. In the context of the present invention, a negative clinical outcome may be an expectation or high probability of TNBC-attributable death or progression. Preferably, a negative clinical outcome means that said subject has a risk of TNBC-attributable death or progression superior to 75%, within 5 years from the initial diagnosis of triple-negative breast cancer.

A “biological sample” according to the invention can be any sample that may be isolated from a subject, including, without limitation, a biological fluid such as blood or a fractional component thereof (serum, plasma, cellular extract), lymph, tumor interstitial fluid, saliva, mucus, sputum, sweat, urine, as well as a tissue biopsy such as a tumor biopsy. Furthermore, in the case of a local or a distant cancer recurrence, a biological sample can further include circulating tumoral cells (CTCs) that may be isolated from a biological fluid as defined above, preferably from blood, by techniques well-known in the art. An example of a technique allowing the isolation of circulating tumoral cells (CTCs) is Dean Flow Fractionation (DFF), as established by Hou et al., 2013. More preferably, the biological sample according to the invention is a tumor biopsy, such as the biopsy of a breast tumor or of a metastasis thereof.

The term biomarker according to the invention preferably refers to a polypeptide or protein, fragment thereof, or epitope that is differentially present in a subject as compared to healthy subjects, including differentially modified (e.g. differentially glycosylated) and/or expressed biomarkers. Examples of biomarkers according to the invention are listed in Tables 1, 2, 6A and 8A, and can be referred herein as “biomarkers of the disclosure”. It should be noted that the term “biomarker” includes soluble biomarkers, i.e. biomarkers which are differentially cleaved, secreted, released or shed from a tumor cell in a subject, and are thus detectable in a biological fluid as defined above. For example, in the context of the present invention, a soluble form of the plasma membrane protein Desmoplakin, as further described below, can be detected from a mere blood sample or a fractional component thereof (Lopez-Farré et al., 2012). “Soluble biomarkers” can be released into a biological fluid through several possible mechanisms, such as local tissue destruction during disease progression. For example, soluble biomarkers may be released into the blood circulation through aberrant shedding and secretion from tumor cells or through destruction of tissue architecture and angiogenesis as the tumor invades. Proteins can also be cleaved from the extracellular surface of tumor cells by proteases and subsequently make their way into the blood circulation. In light of the above, one skilled in the art would readily understand that, if the expression level of a soluble biomarker of interest is to be assessed from a biological sample, said sample is preferably selected from at least one of the biological fluids described above, thereby preventing any invasive act on the patient. A soluble biomarker remains nevertheless detectable within its site of expression, i.e. in the context of the present invention, within a breast tumor or a metastasis thereof.

The term “expression level”, as applied to a biomarker such as a protein, refers herein to the amount or level of a biomarker of interest expressed in a cell, tissue, biological fluid, or organ(s). The term “level” as used herein refers to an amount (e.g. relative amount or concentration) of a biomarker that is detectable or measurable in a sample. For example, the level can be a concentration such as μg/L or a relative amount by comparison to a reference expression level. The act of actually “determining the expression level” of a biomarker in a biological sample refers to the act of actively detecting whether a biomarker is expressed in said sample or not, and notably allows to detect whether the biomarker expression is upregulated, downregulated or substantially unchanged when compared to a reference expression level.

By “reference expression level” or “control expression level” of a biomarker, it is meant a predetermined expression level of said biomarker, which can be used as a reference in any method of the invention. For example, a reference expression level can be the expression level of a biomarker in a biological sample of a healthy subject, or the average or median expression level in a biological sample of a population of healthy subjects.

Additional definitions are provided throughout the specification.

The present invention may be understood more readily by reference to the following detailed description, including preferred embodiments of the invention, and examples included herein.

The inventors have surprisingly discovered key biomarkers associated with recurrence and non-recurrence of triple-negative breast cancer (TNBC). In particular, the inventors have discovered that the expression level of specific biomarkers correlate with disease status and progression. These specific biomarkers can thus allow for a reliable and rapid detection of a TNBC recurrence, and provide a good indication of the clinical outcome.

Accordingly, in a first aspect, the present invention relates to an in vitro method for diagnosing and/or prognosing a triple-negative breast cancer (TNBC) recurrence or non-recurrence in a subject, comprising the steps of:

-   -   a) determining from a biological sample of a subject the         expression level of at least two biomarkers selected from the         group consisting of Desmoplakin, Rho GTPase-activating protein         1, Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate         dehydroge-nase [NADP], Keratin type I cytoskeletal 19, Keratin         type I cytoskeletal 8, Dihydropyrimidinase-related protein 3,         and Thrombospondin-1; and     -   b) comparing said expression level with a reference expression         level of sais biomarkers.

The above method may optionally further comprise the step c) of determining whether said subject is suffering or not from a triple-negative breast cancer (TNBC) recurrence, and/or determining or predicting the clinical outcome in said subject, based upon the comparison in step b).

It shall be understood that said subject has previously been suffering from a primary triple-negative breast cancer (TNBC), and may have been diagnosed as such and/or been treated for it.

As illustrated in the experimental results of the present application, the inventors have discovered that the above mentioned biomarkers are associated with TNBC recurrence, as well as with a poor prognosis.

Particularly preferred biomarkers associated with TNBC recurrence according to the invention are listed in the following Table 1.

TABLE 1 Biomarkers of TNBC recurrence Accession number UniprotKB/Swiss- Prot Symbol Full name (SEQ ID number) DSP or DP Desmoplakin: Isoforms 1 and 2 P15924-1 (Isoform 1: SEQ ID NO: 1) Alternative name(s): P15924-2 (Isoform 2: SEQ ID NO: 2) 250/210 kDA paraneoplastic pemphigus antigen ARHGAP1 Rho GTPase-activating protein 1 Q07960 (SEQ ID NO: 3) Alternative name(s): CDC42 GTPase-activating protein (CDC42GAP) GTPase-activating protein rhoOGAP Rho-related small GTPase protein activator Rho-type GTPase-activating protein 1 (RHOGAP1) p50-RhoGAP EPPK1 Epiplakin P58107 (SEQ ID NO: 4) Alternative name(s): 450 kDa epidermal antigen G6PD Glucose-6-phosphate dehydrogenase P11413-1 (enzyme EC 1.1.1.49): (Isoform short: SEQ ID NO: 5) Isoform short, Isoform long and isoform 3 P11413-2 (Isoform long: SEQ ID NO: 6) P11413-3 (Isoform 3: SEQ ID NO: 7) IDH2 Isocitrate dehydrogenase [NADP] P48735 (SEQ ID NO: 8) (enzyme EC 1.1.1.42) Alternative name(s): ICD-M IDP NADP(+)-specific ICDH Oxalosuccinate decarboxylase KRT19 Keratin type I cytoskeletal 19 P08727 (SEQ ID NO: 9) Alternative name(s): Cytokeratin-19 (CK-19) Keratin-19 (K19) KRT8 Keratin type II cytoskeletal 8: Isoforms 1 and 2 P05787-1 (Isoform 1: SEQ ID NO: 10) Alternative name(s): P05787-2 (Isoform 2: SEQ ID NO: 11) Cytokeratin-8 (CK-8) Keratin-8 (K8) Type-II keratin Kb8 DPYSL3 Dihydropyrimidinase-related protein 3: Q14195-1 (Isoform 1: SEQ ID NO: 12) Isoform 1 and Isoform LCRMP-4 Q14195-2 (Isoform LCRMP-4: SEQ ID Alternative name(s): NO: 13) Collapsin response mediator protein 4 (CRMP-4) Unc-33-like phosphoprotein 1 (ULIP-1) THBS1 Thrombospondin-1 P07996 (SEQ ID NO: 14)

In a preferred embodiment, an expression level of said at least two biomarkers associated with TNBC recurrence as described above, superior to a reference expression level obtained from a biological sample of at least one healthy subject, is indicative that the subject is suffering from a triple-negative breast cancer (TNBC) recurrence, and/or is indicative of a negative clinical outcome.

By superior to a reference expression level, it is preferably meant that the ratio between the expression level of said biomarkers and the reference expression level is above 1.

Notably, with regard to clinical outcome, the inventors have discovered that a higher expression of said biomarkers, compared to a reference expression level, correlates with a low Disease Free Survival rate (DSF), a low Overall Survival rate (OS), an increased risk of death and/or an increased risk of disease progression, as demonstrated in the experimental results.

According to a further preferred embodiment, the above method further comprises the step of determining from the biological sample of said subject the expression level of at least two biomarkers selected from the group consisting of Hexokinase-1, 10 kDa heat shock protein, Ig gamma-1 chain C region, SAM domain and HD domain-containing protein 1, and Tryptophanyl-tRNA synthetase. One skilled in the art will readily understand that a comparison to the expression level of said biomarkers with a reference expression level of said biomarkers is also carried out.

As illustrated in the experimental results of the present application, the inventors have indeed discovered that the above-mentioned biomarkers are associated with TNBC non-recurrence, as well as with a good prognosis.

Particularly preferred biomarkers associated with TNBC non-recurrence according to the invention are listed in the following Table 2.

TABLE 2 Biomarkers of TNBC non-recurrence Accession number UniprotKB/Swiss- Prot Symbol Full name (SEQ ID number) WARS Tryptophanyl-tRNA synthetase P23381-1 (Isoform 1: SEQ ID NO: 15) (enzyme EC 6.1.1.2): Isoforms 1 and 2 P23381-2 (Isoform 2: SEQ ID NO: 16) Alternative name(s): Interferon-induced protein 53 (IFP53) Tryptophanyl-tRNA ligase, cytoplasmique SAMHD1 SAM domain and HD domain-containing protein 1 Q9Y3Z3-1 (Isoform 1: SEQ ID NO: 17) (enzyme EC 3.1.4.—): Isoforms 1 and 2 Q9Y3Z3-2 (Isoform 1: SEQ ID NO: 18) Alternative name(s): Dendritic cell-derived IFNG-induced protein (DCIP) Monocyte protein 5 (MOP-5) HSPE1 10 kDa heat shock protein, mitochondrial P61604 (SEQ ID NO: 19) Alternative name(s): 10 kDa chaperonin Chaperonin 10 (CPN10) Early-pregnancy factor (EPF) IGHG1 Ig gamma-1 chain C region P01857 (SEQ ID NO: 20) HK1 Hexokinase-1 (enzyme EC 2.7.1.1): P19367-1 (SEQ ID NO: 21) Isoforms 1, 2, 3 and 4 P19367-2 (SEQ ID NO: 22) Alternative name(s): P19367-3 (SEQ ID NO: 23) Brain form hexokinase P19367-4 (SEQ ID NO: 24) Hexokinase type I (HK I)

In a preferred embodiment, an expression level of said at least two biomarkers selected from the group consisting of:

-   -   Hexokinase-1, 10 kDa heat shock protein, SAM domain and HD         domain-containing protein 1, and Tryptophanyl-tRNA synthetase,         superior to a reference expression level obtained from a         biological sample of at least one healthy subject, and     -   Ig gamma-1 chain C region, inferior to a reference expression         level obtained from a biological sample of at least one healthy         subject,         is indicative that the subject is not suffering from a         triple-negative breast cancer (TNBC) recurrence, and/or is         indicative of a positive clinical outcome.

By inferior to a reference expression level, it is preferably meant that the ratio between the expression level of said biomarkers and the reference expression level is below 1.

In particular, with regard to clinical outcome, the inventors have discovered that a higher expression of Hexokinase-1, 10 kDa heat shock protein, SAM domain and HD domain-containing protein 1, and/or Tryptophanyl-tRNA synthetase, and/or a lower expression of Ig gamma-1 chain C region, compared to a reference expression level, correlates with a high Disease Free Survival rate (DSF), a high Overall Survival rate (OS), a low risk of death and/or a low risk of disease progression.

The skilled person in the art will readily understand that more than two biomarkers of TNBC recurrence or non-recurrence may be combined as a panel of biomarkers, each of which contributing to the final diagnosis and/or prognosis of the invention. It is within the skill of ordinary person in the art to select the biomarkers to be combined in the present method, as well as in other methods of the invention. Most preferably, the skilled person will combine the nine biomarkers associated with TNBC recurrence and/or the five biomarkers associated with TNBC non-recurrence as described above.

Even though the above listed biomarkers are sufficient to carry out a diagnosis and/or a prognosis, it shall be understood that the information obtained using the methods of the invention as described herein may be used in combination with other information, such as, but not limited to, expression levels of additional biomarkers which may be standard biomarkers, clinical chemical parameters, histopathological parameters, or age, gender and/or weight of the subject.

Thus in a preferred embodiment, the above method further comprises the step of determining from the biological sample of said subject the expression level of at least one additional biomarker of Tables 7A and/or 8A as described below, and any combination thereof. One skilled in the art would readily understand from the data provided herein that the biomarkers listed in Tables 7A and/or 8A may aid in the diagnosis and/or prognosis of the invention. Besides, it should be noted that the numerical values indicated in those tables are provided as a representative example of the expression level of each biomarker; those values are therefore not limiting to the invention, and do not preclude slightly larger and/or slightly smaller values. It is within the skill of ordinary person in the art to select the biomarkers of Tables 7A and/or 8A to be combined in the present method, as well as in other methods of the invention.

In the context of the present invention, the expression level is preferably measured at the protein level. Methods for measuring protein expression levels are well-known in the art and are notably reviewed by Reeves et al. (2000) and Schena (2005). Those methods generally involve contacting a biological sample of interest with one or more detectable reagents that is or are suitable for measuring protein expression level, such as an antibody, and subsequently determining protein expression level based on the level of detected reagent, preferably after normalization. Examples of methods which generally involve the use of an antibody include, without limitation, Western blot, immunoblot, enzyme-linked immunosorbant assay (ELISA), enzyme-linked immunospot (ELISPOT), radioimmunoassay (RIA), immunohistochemistry and immunoprecipitation. Other methods suitable for measuring a protein expression level, which do not necessarily involve the use of an antibody, may be used, including, without limitation, fluorescence activated cell sorting (FACS), microscopy such as atomic force microscopy, flow cytometry, microcytometry, protein binding assay, ligand binding assay, microarray, polyacrylamide gel electrophoresis such as SDS-PAGE, surface plasmon resonance (SPR), Förster resonance energy transfer (FRET), Bioluminescence resonance energy transfer (BRET), chemiluminescence, fluorescent polarization, phosphorescence, mass spectrometry such as liquid chromatography mass spectrometry (LC-MS) or liquid chromatography/mass spectrometry/mass spectrometry (LC-MS-MS), matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF), and magnetic resonance imaging (MRI).

According to the different aspect and preferred embodiments of the present invention, the step of determining the expression level of a biomarker of interest preferably further comprises a substep of normalizing the expression level of said biomarker. The method for normalizing expression level can be selected based upon the method used for measuring expression level. For example, if a Western-blot is performed, the expression level of a biomarker of interest in a biological sample may be normalized by assessing in parallel in said sample the expression level of a protein which is usually constitutively expressed in any cell of a living organism, preferably at the same expression level whether the cell is healthy or not (e.g. cancerous or not). An example of constitutively expressed protein is a housekeeping protein, which may be selected, without limitation, among actin, beta-tubulin, and Glyceraldehyde 3-phosphate dehydrogenase (GAPDH), to name a few. Alternatively, if an ELISA is performed, involving for example a colorimetric detection method, protein expression level can be normalized by total cell number. Yet, still alternatively, if a microarray is performed, protein expression level can be normalized, for example, by loess-regression. For a detailed review of normalization methods of protein expression level in an antibody microarray, one skilled in the art may refer to Hamelinck et al. (2005).

All these methods for measuring and normalizing protein expression level are well-known to the skilled person, and thus do need not to be further detailed herein. Should the skilled person wish to use any of the above methods involving the use of an antibody to measure a biomarker protein expression level, one may use any appropriate commercial antibody specific for said biomarker. Alternatively, based on the knowledge of the amino-acid sequence of a biomarker of interest, it is easy to the skilled person to design suitable reagent(s) to measure expression level in any biological sample. For example, an antibody directed against a specific biomarker may be prepared by any conventional method, e.g. by immunizing an animal, such as a mouse, with an immunogenic form of said biomarker which elicits an antibody response in said animal. Methods for producing polyclonal and monoclonal antibodies are well described in the literature (see notably Kohler and Milstein, 1975; Kozbor et al., 1983; Roder et al., 1986; and Huse et al., 1986), and therefore need not be further detailed herein.

The comparison of a determined or tested expression level with a reference expression level can be done by merely calculating the ratio between the expression level of a biomarker of interest in the tested biological sample and in at least one reference sample, preferably after normalization as described above. Accordingly, a ratio above 1 is indicative that the biomarker is overexpressed, while a ratio below 1 is indicative that the biomarker is underexpressed (i.e. downregulated).

In another aspect of the present invention, the biomarkers disclosed herein can be used to determine if a patient will respond or not to a cancer therapy. Associating a patient's response to treatment with such biomarker(s) can indeed elucidate new opportunities for treatment in non-responding patients or indicate one treatment over other treatment choices.

Therefore, the present invention further provides an in vitro method for determining a drug-responding or non-responding phenotype in a subject suffering from a triple-negative breast cancer recurrence, comprising the steps of:

-   -   a) determining from a biological sample of said subject the         expression level of at least two biomarkers selected from the         group consisting of Desmoplakin, Rho GTPase-activating protein         1, Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate         dehydroge-nase [NADP], Keratin type I cytoskeletal 19, Keratin         type I cytoskeletal 8, Dihydropyrimidinase-related protein 3,         and Thrombospondin-1;     -   b) comparing the expression level in step a) to a reference         expression level of said biomarkers; and     -   c) determining from said comparison the drug-responding or         non-responding phenotype.

According to the present invention, a “drug-responding phenotype” refers to a response state of a subject to the administration of a drug. A “response state” means that said subject responds to the treatment, i.e. that said treatment is efficacious in said subject. A responding phenotype is thus characterized by an improvement in clinical signs, i.e. in the context of the present invention, a responding phenotype is characterized for example by a regression or disappearance of triple-negative breast cancer cells and metastases thereof, if any. A regression or disappearance of cancer cells may be primarily assessed by determining a tumor volume, such as by computed tomography (CT) imaging or magnetic resonance imaging (MRI). By contrast, a “drug-non responding phenotype” refers to the absence in said subject of a state response, meaning that said subject is refractory to the treatment.

In a preferred embodiment, the method as described above further comprises the step of determining from said sample the expression level of at least two biomarkers associated with TNBC non-recurrence as described above.

The skilled person would understand that more than two of the above mentioned biomarkers may be used as a panel of biomarkers, in order to contribute to the determination of a drug-responding or non-responding phenotype according to the method of the invention.

One skilled person would also understand from the data provided herein that the biomarkers listed in Tables 7A and/or 8A may further aid in this determination.

Accordingly, in a preferred embodiment, the method as described above further comprises the step of determining from said sample the expression level of at least one additional biomarker of Tables 7A and/or 8A, as described below.

In a further aspect of the present invention, the biomarkers disclosed herein can be used to design or adapt treatment against a triple-negative breast cancer (TNBC) recurrence. In particular, such treatment may be designed or adapted once a subject has been diagnosed as having a TNBC recurrence, according to the method of the invention.

Accordingly, the present invention provides herein a method for designing or adapting a treatment regimen for a subject suffering from a triple-negative breast cancer (TNBC) recurrence, comprising the steps of:

-   -   a) determining from a biological sample of said subject a         drug-responding or non-responding phenotype, according to the         method described above; and     -   b) designing or adapting a treatment regimen for said subject         based upon said responding or non-responding phenotype.

The present method is particularly useful for offering a therapy tailored to each patient affected by a TNBC recurrence.

The term “treatment regimen” refers herein to a treatment plan that specifies the type of treatment (i.e. type of drug or combination of drugs and mode of administration of said drug(s)), dosage, schedule and/or duration of a treatment provided to a subject in need thereof. A dosage, schedule and/or duration of treatment can vary, depending on the progression of disease and the selected type of treatment. In this regard, in addition to the drugs that can be identified according to the screening method of the invention, therapeutic agents that may be used in the treatment regimen according to the invention include, without limitation, chemotherapeutic agents, vascular endothelial growth factor receptor (VEGFR) inhibitors such as bevacizumab, epidermal growth factor receptor (EGFR) inhibitors such as cetuximab and panitumumab, tyrosine kinase inhibitors, poly (ADP-ribose) polymerase (PARP) inhibitors, transmembrane glycoprotein NMB (GPNMB) inhibitors such as glembatumumab vedotin (CDX-011), and any combination thereof.

Standard chemotherapeutic drugs for treating breast cancer include, without limitation, platinum-based agents such as oxaliplatin, cisplatin, carboplatin, spiroplatin, iproplatin, and satraplatin; alkylating agents such as cyclophosphamide, ifosfamide, chlorambucil, busulfan, melphalan, mechlorethamine, uramustine, thiotepa, and nitrosoureas; anti-metabolites such as 5-fluorouracil, azathioprine, 6-mercaptopurine, methotrexate, leucovorin, capecitabine, cytarabine, floxuridine, fludarabine, gemcitabine, pemetrexed, or raltitrexed; plant alkaloids such as vincristine, vinblastine, vinorelbine, vindesine, podophyllotoxin, or taxanes such as paclitaxel and docetaxel; topoisomerase inhibitors such as irinotecan, topotecan, amsacrine, etoposide (VP16), etoposide phosphate, or teniposide; antitumor antibiotics such as anthracyclines (e.g. doxorubicin, daunorubicin, epirubicin, mitoxantrone), actinomycin, bleomycin, mitomycin, or plicamycin; and any combination thereof.

Examples of tyrosine kinase inhibitors that can be used in the treatment regimen according to the invention include, without limitation, dasatinib, gefitinib, sunitinib, erlotinib, lapatinib, canertinib, semaxinib, vatalanib, sorafenib, imatinib mesylate, leflunomide, vandetanib, pelitinib, CP-654577, CP-724714, HKI-272, PKI-166, AEE788, BMS-599626, HKI-357, BIBW 2992, ARRY-334543, JNJ-26483327, JNJ-26483327, and any combination thereof.

Examples of poly (ADP-ribose) polymerase (PARP) inhibitors that can be used in the treatment regimen according to the invention include, without limitation, olaparid (AZD-2281), iniparib (BSI-201), rucaparib (AG014699, PF-01367338), veliparib (ABT-888), CEP 9722, MK 4827, BMN-673, 3-aminobenzamide, and any combination thereof.

Particularly preferred treatment regimen according to the invention consists in the combination of three agents (“triplet therapy” or “triplet treatment regimen”). For example, three therapeutic agents of distinct categories may be combined, said agents being selected from a chemotherapeutic agent, a vascular endothelial growth factor receptor (VEGFR) inhibitor, an epidermal growth factor receptor (EGFR) inhibitor, a tyrosine kinase inhibitor, a poly (ADP-ribose) polymerase (PARP) inhibitor, and/or a transmembrane glycoprotein NMB (GPNMB) inhibitor, as defined above. Another example of a triplet therapy can include an inhibitor of a biomarker associated with TNBC recurrence along with two therapeutic agents of distinct categories as described above.

In the above method, the treatment regimen that is designed or adapted and optionally administered to the subject depends on the responding or non-responding phenotype. In particular, a treatment regimen may be selected for the first time, continued, adjusted or stopped based upon said phenotype. For example, a treatment regimen may be adjusted by increasing the dose to be administered, or stopped and switched to an alternative treatment regimen, if the subject is non-responding. Still, alternatively, a treatment regimen may be selected for the first time or continued if a subject is responding. One skilled in the art would nevertheless easily design or adjust the type of treatment with the dosage, schedule and duration of treatment, depending upon the phenotype of the subject.

Furthermore, based upon said phenotype, the selected treatment regimen can be an aggressive one which is expected to result in the best clinical outcome (e.g., regression and/or disappearance of triple-negative breast cancer cells and metastases thereof, if any) and which may be associated with some discomfort to the subject or adverse side effects (e.g., damage to healthy cells or tissue). An example of aggressive treatment regimen include a treatment regimen as described above combined with surgical intervention to remove tumoral cells, tissue or organs and/or an exposure to radiation therapy. An aggressive treatment regimen may also include a higher dosage of the therapeutic agent(s), a more frequent administration of said agent(s), and/or a longer duration of treatment.

Thus, once a treatment regimen has been determined in accordance with the teachings of the invention, the subject may receive the appropriate treatment.

Therefore, in another aspect, the invention relates to a method for treating a triple-negative breast cancer recurrence in a subject in need thereof, comprising the steps of:

-   -   a) determining from a biological sample of said subject a         drug-responding or non-responding phenotype, according to the         method described above; and     -   b) administering to said subject said drug if the phenotype is a         responding phenotype.

The term “administering” as used herein means that the drug(s) of interest is delivered or dispensed to a subject orally, or parenterally such as by subcutaneous, intravenous, intramuscular, intrathecal or intraperitoneal injection.

In another aspect of the present invention, the biomarkers disclosed herein may be used for drug screening purposes. In particular, novel drug assays may be provided, which identify therapeutics efficiently interfering with the proliferation of triple-negative breast cancer cells that aberrantly express those biomarkers. Current treatment of triple-negative breast cancer (TNBC) mainly relies on chemotherapy and/or antiangiogenic drugs, which may be combined, if need be, with surgery. However, with chemotherapy alone, the residual risk of recurrence remains high, between 30 to 40%. Furthermore, as indicated above, endocrine and anti-HER2 therapy are usually not indicated for TNBC patients, as those are negative for the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). The present invention thus provides a novel screening assay to identify candidate drugs that are targeted to triple-negative breast cancer recurrence.

In this aspect, the present invention more particularly relates to a screening method for identifying a drug or combination of drugs suitable for treating a triple-negative breast cancer recurrence, comprising the steps of:

-   -   a) contacting isolated breast cancer cells or cell line         displaying a triple-negative breast cancer recurrence phenotype         with a candidate drug or combination of candidate drugs;     -   b) determining, from said cells or cell line contacted with said         drug or combination of drugs, the expression level of at least         two biomarkers selected from the group consisting of         Desmoplakin, Rho GTPase-activating protein 1, Epiplakin,         Glucose-6-phosphate 1-dehydrogenase, Isocitrate dehydroge-nase         [NADP], Keratin type I cytoskeletal 19, Keratin type I         cytoskeletal 8, Dihydropyrimidinase-related protein 3, and         Thrombospondin-1; and     -   c) comparing the expression level of said biomarkers in step b)         to their expression level in the absence of said drug or         combination of drugs.

By “drug” or “agent”, it is meant herein a compound such as chemical or a biological molecule that can be administered or tested according to the invention. A chemical can be of any composition such as inorganic or organic. A biological molecule can be a molecule of any biological origin that can be found in or produced by, at least in part, a cell, such as, without limitation, peptides or proteins such as antibodies or affibodies, lipids, nucleic acids such as RNAi or aptamers, carbohydrates, and any combination thereof.

By “drug suitable for treating a TNBC recurrence”, it is meant herein a drug that can slow or stop the growth of triple-negative breast cancer cells and metastases thereof, if any, either by killing said cells, or by slowing or stopping their uncontrolled division.

Furthermore, it shall be understood that by “breast cancer cells or cell line displaying a TNBC recurrence phenotype” according to the invention, it is meant breast cancer cells or cell line that exhibit(s) the same expression profile of the biomarker(s) associated with triple-negative breast cancer recurrence as the one described above, such as the expression profile described in Table 7A. Preferably, the cells or cell line used in the present screening method are breast cancer cells or cell line isolated from a subject suffering from a triple-negative breast cancer recurrence.

The screening method described above is preferably an in vitro screening method. For example, the cells or cell line used in the present method can be cultured in a three-dimensional (3D) culture system, so as to mimic a TNBC tumor micro-environment. To do so, said cells can be embedded in an extracellular matrix (ECM) as described by Weigelt et al. (2008), Kenny et al. (2007) and Li et al. (2010).

In order to assess the efficacy of the candidate anti-cancer agent, said cells or cell line may, as an alternative or as a validation test, be grafted to an animal, such as a mouse. This procedure, also known as a xenograft, has successfully been used to assess the efficacy of metformin on TNBC mice xenografts (Liu et al., 2009). Should such xenograft be carried out, the screening method described above preferably further comprises the step of killing said animal.

In a preferred embodiment of the above method, an expression level of said biomarkers in step b) inferior to their expression level in the absence of said drug or combination of drugs is indicative that said drug or combination of drugs is suitable for treating a TNBC recurrence.

Preferably, an expression level of the nine biomarkers in step b) inferior to their expression level in the absence of said drug or combination of drugs is indicative that said drug or combination of drugs is suitable for treating a TNBC recurrence.

Yet, in a preferred embodiment, the screening method of the invention further comprises the step of determining, from said cells or cell line, the expression level of at least one additional biomarker of Table 7A as described below. One skilled in the art would readily understand from the data provided herein that the biomarkers listed in Table 7A may aid in the identification of a drug or combination of drugs suitable for treating a TNBC recurrence.

In another aspect, the present invention provides kits that can be employed in the methods described herein. In this regard, the invention relates to a kit for use in any method described above, comprising or consisting of:

-   -   a) a reagent capable of specifically determining the expression         level of at least two biomarkers selected from the group         consisting of Desmoplakin, Rho GTPase-activating protein 1,         Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate         dehydroge-nase [NADP], Keratin type I cytoskeletal 19, Keratin         type I cytoskeletal 8, Dihydropyrimidinase-related protein 3,         and Thrombospondin-1; and     -   b) instructions for performing said method.

As used herein, the term “instructions” refers to a publication, a recording, a diagram, or any other medium which can be used to communicate how to perform a method of the invention. Said instructions can, for example, be affixed to a container which contains said kit. Preferably, the instructions for using said kit include a reference expression level of said biomarkers.

The term “reagent capable of specifically determining the expression level” designates a reagent or a set of reagents which specifically recognizes given biomarker(s) and allows for the quantification for the expression level of said biomarker(s). These reagents can be for example antibodies, aptamers or affibodies specifically recognizing a biomarker. In the context of the present invention, such reagent is said to be “specific” for its target (i.e. biomarker) or “recognizes specifically” its target if it 1) exhibits a threshold level of binding activity, and/or 2) does not significantly cross-react with target molecules known to be related to the biomarker of interest. The binding affinity of such reagent can be easily determined by one skilled in the art, for example, by Scatchard analysis. Cross-reactivity of a reagent can as well be easily determined by one skilled in the art, and thus need to be further detailed herein. Examples of reagents capable of specifically determining the expression level of a biomarker include, without limitation, antibodies.

In a preferred embodiment, the kit of the invention may further comprise:

-   -   c) a reagent capable of specifically determining the expression         level of at least two biomarkers associated with TNBC         non-recurrence as described above.

Yet, in a further preferred embodiment, the kit of the invention further comprises a reagent capable of specifically determining the expression level of at least one additional biomarker of Table 7A and/or 8A, as further described below, and any combination thereof.

In order to normalize protein expression level, the kit of the invention may also optionally comprise a reagent capable of specifically determining the expression level of a housekeeping protein, such as actin, beta-tubulin, or Glyceraldehyde 3-phosphate dehydrogenase (GAPDH).

In yet another aspect, the methods of the invention can be practiced using a microarray, so as to notably determine the expression level of biomarkers of interest in the present invention.

The term “microarray” refers herein to a spatially defined and separated collection of individual biological molecules which are immobilized on a solid surface, and to which one or several biomarkers of interest specifically bind(s). Those biological molecules allow for the determination of the expression level of said biomarker(s), and may be antibodies, affibodies or aptamers if the microarray is a protein microarray, which is a preferred type of microarray according to the invention. Protein microarrays technologies are well-known to the skilled person, and are notably described in Mitchell (2002), Haab (2005), and Eckel-Passow et al. (2005), and in U.S. Pat. Nos. 6,087,102, 6,139,831, and 6,087,103. For determination of protein expression level of one or several biomarkers by using such array, two technologies can typically be used: 1) direct labeling, and 2) indirect labeling, as described for example by Kingsmore et al. (2006). In the “direct labeling” method, the protein of interest (i.e. biomarker of the invention, or target) obtained from a sample, such as a biological sample, is labeled with a specific marker (e.g. a fluorescent or a radioisotope marker), and subsequently hybridized to the microarray by specifically binding to a reagent recognizing said biomarker, said reagent being conjugated to the surface of the protein microarray. If the expression level of several biomarkers is to be assessed, each biomarker is labeled with a distinct marker. In the “indirect labeling” method, the sample containing the biomarker of interest is hybridized to the microarray by specifically binding to an unlabeled reagent recognizing said biomarker, said reagent being conjugated to the surface of the protein microarray, and a secondary labeled reagent, specifically recognizing as well said biomarker, is then added. The specificity and sensitivity of such indirect labeling method can further be enhanced by using a third labeled reagent, recognizing the secondary reagent (sandwich assay). Similarly, if the expression level of several biomarkers is to be assessed in the indirect labeling method, each secondary or third reagent is labeled with a distinct marker. Label-free systems may also be used to determine the expression level of a biomarker on a protein microarray; in such system, detection of the biomarker, and hence of its expression level, may be done by surface plasmon resonance (SPR), microcantilever biosensing, SELDI-TOF-MS, or atomic force microscopy (Chandra et al., 2011).

Therefore, the invention further relates herein to a protein microarray for use in any method described above, comprising or consisting of:

-   -   a) a reagent capable of specifically determining the expression         level of at least two biomarkers selected from the group         consisting of Desmoplakin, Rho GTPase-activating protein 1,         Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate         dehydroge-nase [NADP], Keratin type I cytoskeletal 19, Keratin         type I cytoskeletal 8, Dihydropyrimidinase-related protein 3,         and Thrombospondin-1.

In a preferred embodiment, the protein microarray of the invention may further comprise:

-   -   b) a reagent capable of specifically determining the expression         level of at least two biomarkers associated with triple-negative         breast cancer (TNBC) non-recurrence as described above.

Yet, in a further preferred embodiment, the microarray of the invention further comprises a reagent capable of specifically determining the expression level of at least one additional biomarker of Table 7A and/or 8A, as further described below, and any combination thereof.

In order to normalize protein expression level, the microarray of the invention may also optionally comprise a reagent capable of specifically determining the expression level of a housekeeping protein, such as actin, beta-tubulin, or Glyceraldehyde 3-phosphate dehydrogenase (GAPDH).

The present invention will be better understood in the light of the following detailed description of experiments, including examples. Nevertheless, the skilled artisan will appreciate that this detailed description is not limitative and that various modifications, substitutions, omissions, and changes may be made without departing from the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Schematic workflow of experimental design and data analysis of the present invention.

FIG. 2. Tumor classification by orthogonal partial least squares analysis (OPLS) in the global analysis.

FIG. 3. Immunoblot analysis of the WARS and THBS1 biomarkers expression in relapsing and non-relapsing subject. Six and seven “Relapse” tumors and six and eight “No Relapse” tumors were immunoblotted. HSC70 was used as a control.

FIG. 4. Kaplan-Meier estimates of disease-free survival for WARS (A), HSPE1 (B), SAMHD1 (C), HK1 (D), and IGHG1 (E) expression.

FIG. 5. Kaplan-Meier estimates of overall survival for WARS (A), HSPE1 (B) and IGHG1 (C) expression.

FIG. 6. Kaplan-Meier estimates of disease-free survival for DSP (A), THBS1 (B), G6PD (C), IDH2 (D), KRT19 (E), KRT8 (F), EPPK1 (G), ARHGAP1 (H) and DPYSL3 (I) expression.

FIG. 7. Kaplan-Meier estimates of overall survival for DSP (A), THBS1 (B), G6PD (C), and IDH2 (D) expression.

FIG. 8. Kaplan-Meier curves for the biomarkers DSP (A,B), THBS1 (C,D) and IGHG1 (E,F) (disease free survival on the left (A,C,E) and overall survival on the right (B,D,F)).

FIG. 9. Validation of DSP in the serum samples of a triple-negative breast cancer cohort.

EXAMPLES 1. Materials and Methods

1.1. Sample Collection

The inventors selected cases of triple negative breast tumors (TNBC) that were surgically resected with curative intent in the West Cancer Institute tumor bank. All patients provided informed consent for participation and this project was approved by the Institutional Review Board. All specimens were collected immediately after surgery, snap frozen and stored in liquid nitrogen until the time of analysis. We also selected 4 normal macroscopically areas for our control pool. Frozen sections (12 μm thick) of either TNBC or normal areas were cut on a cryostat (Bright Instrument Co Ltd, St Margarets Way, UK). Specific sections were stained with toluidine blue for visual reference and each tissue sections from all specimens were evaluated by experienced pathologists for cancer cell proportion determination. Samples containing less than 80% of tumor cells were removed. Clinical features of tissue candidates are summarized in Table 3 below.

TABLE 3 Clinico-pathological characteristics of patients for tissue proteomic studies Total Non recurrence Recurrence (n = 80) (n = 45) (n = 35) Age Median (range) 56 (28-78) 55 (28-78) 58 (37-76) Grade 1 1 0 1 2 6 6 0 3 73 39 34 pT 08-11 6 5 1 12-15 23 16 7 16-19 11 7 4 20-23 15 10 5 24-27 6 4 2 28-31 5 2 3 32-35 6 4 2 36-70 7 3 4 Adjuvant chemotherapy 3 2 1 Radiotherapy 77 49 28

1.2. Protein Extraction from Frozen Tissues

Frozen sections (12 μm thick) of TNBC or normal breast area were cut on a cryostat (Bright Instrument Co Ltd, St Margarets Way, UK). Specific sections were stained with toluidine blue for visual reference. Ten frozen sections per tumor were lysed in a buffer consisting of 0.1 M Tris-HCl, pH 8.0, 0.1 M DTT, and 4% SDS at 95° C. for 90 min. Detergent was removed from the lysates and the proteins were digested with trypsin using the FASP protocol (Wisniewski et al., 2009) using spin ultrafiltration units of nominal molecular weight cut of 30 000. To YM-30 microcon filter units (Cat No. MRCF0R030, Millipore) containing protein concentrates, 200 μL of 8 M urea in 0.1 M Tris/HCl, pH 8.5 (UA), was added and samples were centrifuged at 14 000 g at 20 C for 8 min. This step was performed thrice. Then 6 μL of 200 mM MMTS in 8 M urea was added to the filters and the samples were incubated for 20 min. Filters were washed thrice with 200 μL of 8 M UA followed by six washes with 100 μL 0.5M TEAB. Finally, trypsin (AB sciex) was added in 100 μL 0.5M TEAB to each filter. The protein to enzyme ratio was 100:1. Samples were incubated overnight at 37° C. and released peptides were collected by centrifugation. Samples were then dried completely using a Speed-Vac and re-suspended in 100 μl of 0.5% trifluoroacetic acid (TFA) in 5% acetonitrile, and were desalted via PepClean C-18 spin columns (Pierce Biotechnology, Rockford, Ill.). Peptide content was determined using Micro BCA Protein Assay Kit (Pierce-Thermo Scientific, Rockford, Ill.).

1.3. Peptide Labelling with iTRAQ Reagents

Each peptide solution was labelled at room temperature for 2 h with one iTRAQ reagent vial previously reconstituted with 70 μl of ethanol for 4plex iTRAQ reagent and reconstituted with 50 μl of isopropanol for 8plex iTRAQ reagent. A mixture containing small aliquots from each labeled sample was analyzed by MS/MS to determine a proper mixing ratio to correct for unevenness in peptide yield from Liquid Tissues procedures. Labeled peptides were then mixed in 1:1:1:1 (or 1:1:1:1:1:1:1:1) ratio. Peptide mixture was then dried completely using a Speed-Vac.

1.4. Peptide OFFGEL Fractionation

For pI-based peptide separation, the inventors used the 3100 OFFGEL Fractionator (Agilent Technologies, Böblingen, Germany) with a 24-well set-up according to the protocol described by Ernoult et al. (2008). Briefly, prior to electrofocusing, samples were desalted onto a Sep-Pak C18 cartridge (Waters). For 24-well set-up, peptide samples were diluted to a final volume of respectively 3.6 mL using OFFGEL peptide sample solution. To start, the IPG gel strip of 24 cm-long (GE Healthcare, Munchen, Germany) with a 3-10 linear pH range was rehydrated with the Peptide IPG Strip Rehydradation Solution according to the protocol of the manufacturer for 15 min. Then, 150 μL of sample was loaded in each well. Electrofocusing of the peptides was performed at 20° C. and 50 μA until the 50 kVh level was reached. After focusing, the 24 peptide fractions were withdrawn and the wells were washed with 200 μL of a solution of water/methanol/formic acid (49/50/1). After 15 min, the washing solutions were pooled with their corresponding peptide fraction. All fractions were evaporated by centrifugation under vacuum and maintained at −20° C. Just prior nano-LC, the fractions were resuspended in 20 μL of H₂O with 0.1% (v/v) TFA.

1.5. Capillary LC Separation

The samples were separated on an Ultimate 3,000 nano-LC system (Dionex, Sunnyvale, USA) using a C18 column (PepMap100, 3 μm, 100 A, 75 μm id×15 cm, Dionex) at 300 nL/min a flow rate. Buffer A was 2% ACN in water with 0.05% TFA and buffer B was 80% ACN in water with 0.04% TFA. Peptides were desalted for 3 min. using only buffer A on the precolumn, followed by a separation for 105 min. using the following gradient: 0 to 20% B in 10 min, 20% to 45% B in 85 min and 45% to 100% B in 10 min. Chromatograms were recorded at the wavelength of 214 nm. Peptide fractions were collected using a Probot microfraction collector (Dionex). We used CHCA (LaserBioLabs, Sophia-Antipolis, France) as MALDI matrix. The matrix (concentration of 2 mg/mL in 70% ACN in water with 0.1% TFA) was continuously added to the column effluent via a micro “T” mixing piece at 1.2 μL/min flow rate. After 12 min run, a start signal was sent to the Probot to initiate fractionation. Fractions were collected for 10 s and spotted on a MALDI sample plate (1,664 spots per plate, Applied Biosystems, Foster City, Calif.).

1.6. MALDI-MS/MS

MS and MS/MS analyses of off-line spotted peptide samples were performed using the 5800 MALDI-TOF/TOF Analyser (ABsciex) and 4000 Series Explorer software, version 4.0. The instrument was operated in a positive ion mode and externally calibrated using a mass calibration standard kit (ABsciex). The laser power was set between 2800 and 3400 for MS and between 3600 and 4200 for MS/MS acquisition. After screening all LC-MALDI sample positions in MS-positive reflector mode using 1500 laser shots, the fragmentation of automatically-selected precursors was performed at a collision energy of 1 kV using air as collision gas (pressure of ˜2×10-6 Torr) with an accumulation of 2000 shots for each spectrum. MS spectra were acquired between m/z 1000 and 4000. For internal calibration, we used the parent ion of Glu1-fibrinopeptide at m/z 1570.677 diluted in the matrix (30 femtomoles per spot). Up to 12 of the most intense ion signals per spot position having a S/N>12 were selected as precursors for MS/MS acquisition. Peptide and protein identification were performed by the ProteinPilot™ Software V 4.0 (AB Sciex) using the Paragon algorithm as the search engine (Shilov et al., 2007).

Each MS/MS spectrum was searched for Homo sapiens specie against the Uniprot/swissprot database (UniProtKB/Sprot 20110208 release 01, with 525997 sequence entries). The searches were run using with the fixed modification of methylmethanethiosulfate labeled cysteine parameter enabled. Other parameters such as tryptic cleavage specificity, precursor ion mass accuracy and fragment ion mass accuracy are MALDI 5800 built-in functions of ProteinPilot software. The detected protein threshold (unused protscore (confidence)) in the software was set to 1.3 to achieve 95% confidence, and identified proteins were grouped by the ProGroup algorithm (ABsciex) to minimize redundancy. The bias correction option was executed.

A decoy database search strategy was also used to estimate the false discovery rate (FDR), defined as the percentage of decoy proteins identified against the total protein identification. The FDR was calculated by searching the spectral against the Uniprot Homo sapiens decoy database. The estimated low FDR of 0.9% indicated a high reliability in the identified proteins.

1.7. Quantification of Relative Protein Expression.

The inventors employed a customized software package, iQuantitator (Schwacke et al., 2009; Grant et al., 2009; and Besson et al., 2011) to infer the magnitude of change in protein expression. The software infers treatment-dependent changes in expression using Bayesian statistical methods. Basically, this approach was used to generate means, medians, and 95% credible intervals (upper and lower) for each treatment-dependent change in protein expression by using peptide-level data for each component peptide, and integrating data across the two experiments. For proteins whose iTRAQ ratios were downregulated in tissues, the extent of downregulation was considered further if the higher limit of the credible interval had a value lower than 1. Conversely, for proteins whose iTRAQ ratios were up-regulated in tumors, the extent of upregulation was considered further if the lower limit of the credible interval had a value greater than 1. The width of these credible intervals depends on the data available for a given protein. Since the number of peptides observed and the number of spectra used to quantify the change in expression for a given protein are taken into consideration, it is possible to detect small but significant changes in up- or downregulation when many peptides are available. For each protein, and each peptide associated with a given protein, the mean, median, and 95% credible intervals were computed for each of the protein- and peptide-level treatment effects.

The peptide selection criteria for relative quantification were performed as follows. Only peptides unique for a given protein were considered for relative quantification, excluding those common to other isoforms or proteins of the same family. Proteins were identified on the basis of having at least one peptide with an ion score above 95% confidence. The protein sequence coverage (95%) was estimated for specific proteins by the percentage of matching amino acids from the identified peptides having confidence greater than or equal to 95% divided by the total number of amino acids in the sequence.

1.8. Functional Annotation and Network Analysis

Gene ontology (GO) terms for identified proteins were extracted, and overrepresented functional categories for differentially abundant proteins were determined by the high throughput GOMiner tool (National Cancer Institute) (Zeeberg et al., 2005). All proteins that were subjected to iQuantitator analysis served as the background list, and GO terms with at least five proteins were used for statistical calculations. A p value for each term was calculated via the one-sided Fisher's exact test, and FDR was estimated by permutation analysis using 1000 randomly selected sets of proteins sampled from the background list. Statistically significant (FDR <25%) GO terms were clustered based on the correlation of associated proteins to minimize potential redundancy in significant GO terms.

1.9. Western Blot Analysis of Proteins in TNBC

Freezed tumors were mounted in OCT and cut with a cryostat (Starlet 2212). Forty 12 μm sections were then lysed in FASP buffer (4% SDS, 0.1 M Tris) for 90 min at 95° C., sonicated 3 times and centrifugated 10 min RT at 13200 rpm. Protein concentration was evaluated using Pierce BCA protein assay kit (Thermo scientific, #23225). Western blot on tumor lysates were performed as described previously (Besson et al., 2011). Briefly, 50 μg of tumor lysates were loaded on 12% polyacrylamide gel and then transferred onto PVDF membrane. After blocking with 5% BSA in TBS (0.1 M, pH 7.4), blots were incubated with the respective primary antibodies at 4° C. overnight (Thrombospondin-1: Abcam Ab1823 1/500, 10 kDa heat shock protein: Abcam Ab108600 1/10000, Tryptophanyl-tRNA synthetase: Abcam Ab 92733 1/10000). The protein abundance of Hsc70 was used as a control for protein loading and was determined with mouse anti Hsc from Santa Cruz sc-7278 1/500 2 h at room temperature. The membranes were incubated with the respective secondary antibody, horseradish peroxidase-conjugated rabbit anti-IgG (goat anti-rabbit IgG-HRP sc-2004, 1:4000; Santa Cruz Biotechnology Inc.) or horseradish peroxidase-conjugated mouse anti-IgG (goat anti-mouse IgG-HRP, sc-2005, 1:4000; Santa Cruz Biotechnology Inc.), for 45 min at room temperature. After each step, blots were washed three times with 0.05% Tween, TBS. The membrane was probed with the indicated antibodies and developed with the ECL on a Chemidoc System (Bio-Rad).

1.10. ELISA (Enzyme-Linked Immunosorbent Assay)

Commercially available ELISA kits from USCN Life Science Inc. or R&D were used to assay concentrations of Decorin, Asporin and Thrombospondin-1. The kits consisted of 96-well microtiter plates coated with antibody specific to each type of molecule, detection antibodies for identifying the antibody-protein in the plate by streptavidin-biotin labeling and TMB substrate which generated colored product. The sample was added and assay was conducted according to the manufacturer's instruction. The absorbance of the colored product developed at the end of the assay was quantified at wavelength 450 nm on ELISA reader (Tecan Magellan Sunrise). Dilutions of the serums are indicated in Table 4 below.

TABLE 4 Proteins Supplier Reference serum dilution DECORIN USCN Life E92127Hu ⅕ in PBS Science Inc. ASPORIN USCN Life E92321Hu ⅕ in PBS Science Inc. THROMBOSPONDIN-1 R&D Quantikine 1/100 in Systems DTSP10 RD5-33 1X (supplied by Manufacturer)

2. Results

2.1. Identification of Expressed Proteins: Proteomic Coverage of 80 Triple-Negative Breast Tumors

Using Protein Pilot and iQuantitator softwares, the inventors identified and quantified a total of 2805 non-redundant proteins with at least 2 peptides, according the schematic workflow of experimental design in FIG. 1. By taking into consideration both the peptide and spectra numbers, this approach allowed us to detect small but significant expression changes, provided that several peptides are detected (data not shown). Using this analysis, the inventors were able to obtain a list of quantified proteins from the twenty iTRAQ experiments. Examining these proteins with the function “Enrichment of protein function” of Metacore (Table 5A), the inventors characterized among all the proteins, 690 enzymes, 58 phosphatases, 122 proteases, 105 kinases, 73 ligands, 82 transcription factors and 83 receptors. This analysis showed that the best enrichment score and p-value were assigned to the GO Process “Metabolic Process” (Table 5B) and to the Pathway maps “Cytoskeleton Remodeling” (Table 5C).

TABLE 5A Enrichment by protein function Percentage Protein In In function Protein data protein in class Actual n R N Expected Ratio p-value z-score set function database Enzymes 690 3099 2724 23844 354 1.949 8.622E−78 20.34 22.27% 25.33% 11.42% Phosphatases 58 3099 230 23844 29.89 1.94 3.724E−07 5.538 1.87% 25.22% 0.96% Proteases 122 3099 559 23844 72.65 1.679 3.748E−09 6.281 3.94% 21.82% 2.34% Kinases 105 3099 654 23844 85 1.235 1.234E−02 2.358 3.39% 16.06% 2.74% Ligands 73 3099 514 23844 66.8 1.093 2.230E−01 0.8215 2.36% 14.20% 2.16% Transcription 82 3099 959 23844 124.6 0.6579 7.007E−06 −4.18 2.65% 8.55% 4.02% factors Receptors 83 3099 1565 23844 203.4 0.4081 2.446E−25 −9.363 2.68% 5.30% 6.56% Other 1891 3099 16691 23844 2169 0.8717 1.285E−30 −11.7 61.02% 11.33% 70.00% Columns have the following meaning: Protein class: a broadly defined protein function; Actual: number of network objects from the activated dataset(s) for a given protein class; n: number of network objects in the activated dataset(s); R: number of network objects of a given protein class in the complete database or background list; N: total number of network objects in the complete database or background list; Expected: mean value for hypergeometric distribution (n*R/N); Ratio: connectivity ratio (Actual/Expected); z-score: z-score ((Actual-Expected)/sqrt(variance)); p-value: probability to have the given value of Actual or higher (or lower for negative z-score); In data set: fraction of network objects with a selected function in the activated dataset; In protein function: fraction of network with a selected function in the activated dataset among; network objects with this function in the complete database or background list; Protein function in database: fraction of network objects with a selected function in the complete database or background list.

TABLE 5B Pathway maps Pathway maps p-Value ratio 1 Cytoskeleton remodeling_Cytoskeleton remodeling 1.008e−20  55/102 2 Cytoskeleton remodeling_Keratin filaments 5.196e−16 27/36 3 LRRK2 in neurons in Parkinson's disease 4.337e−15 25/33 4 Cytoskeleton remodeling_TGF, WNT and cytoskeletal remodeling 8.787e−15  50/111 5 Cytoskeleton remodeling_Regulation of actin cytoskeleton by Rho GTPases 1.902e−14 20/23 6 Cell adhesion_Integrin-mediated cell adhesion and migration 2.581e−12 28/48 7 Cell adhesion_Chemokines and adhesion 9.170e−11  41/100 8 Apoptosis and survival_Granzyme A signaling 1.152e−10 20/30 9 Transport_Clathrin-coated vesicle cycle 1.174e−10 33/71 10 Immune response_Alternative complement pathway 1.760e−10 23/39

TABLE 5C Gene Ontology (GO) process Processes p-Value ratio 1 metabolic process 7.084e−193  2305/10691 2 cellular metabolic process 4.692e−171 2079/9418 3 primary metabolic process 1.426e−158 2081/9619 4 cellular process 6.761e−152  2875/15962 5 catabolic process 5.562e−151  790/2270 6 small molecule metabolic process 1.146e−145  910/2880 7 cellular catabolic process 2.285e−142  695/1910 8 cellular component organization or 1.902e−139 1255/4755 biogenesis 9 cellular component organization or 1.762e−131 1090/3947 biogenesis at cellular level 10 cellular component organization 2.660e−129 1204/4596

Among these 2805 proteins, 219 proteins met the inventors' definition for differential expression in a comparison between tumor and normal tissues: 126 were overexpressed and 93 were underexpressed (Table 6A). The inventors subjected the 219 identified proteins that were differentially expressed in triple-negative breast tumors to Metacore analysis and categorized them, in a first time, according to molecular function and biological process. When the inventors analyzed the dysregulated proteins for molecular function, they found that the best enrichment score and p-Value were assigned to the GO terms Protein binding, MHC class I receptor activity and GTPase activity (p=2.0 10⁻¹³), which included 7 members RAS oncogen family (Table 6B). When the inventors grouped dysregulated proteins based on biological processes, they found that the best GO term score was obtained with cytoskeleton organization (p=9.2 10⁻¹⁶) (Table 6C). Finally, when the inventors analyzed the enrichment of protein function of these dysregulated proteins, they found that the first class with the best z-score was “ligands” with 14 proteins, indicating potentially biomarker candidates (Table 6D).

TABLE 6A Proteins underexpressed and overexpressed in triple-negative breast cancer confidence intervals Peptide Gene Protein Mean min max number EEF1A1 Elongation factor 1-alpha 1 3.325 2.191 5.243 12 HLA-A HLA class I histocompatibility antigen. A-33 alpha 2.594 1.935 3.498 4 chain KRT8 Keratin type II cytoskeletal 8 2.698 1.747 4.278 14 MAPK13 Mitogen-activated protein kinase 13 2.9 1.601 5.366 2 TUBA1C Tubulin alpha-1C chain 3.593 1.537 8.237 5 NME1 Nucleoside diphosphate kinase A 2.045 1.462 2.906 6 YBX1 Nuclease-sensitive element-binding protein 1 1.955 1.395 2.714 6 HSPA8 Heat shock cognate 71 kDa protein 5.889 1.372 31.395 27 ITGAM Integrin alpha-M 2.086 1.357 3.218 5 TPM3 Tropomyosin alpha-3 chain 1.886 1.345 2.686 8 NAMPT Nicotinamide phosphoribosyltransferase 1.992 1.341 3.104 12 NME2 Nucleoside diphosphate kinase B 1.791 1.326 2.442 11 RAB5A Ras-related protein Rab-5A 2.095 1.312 3.464 4 USP15 Ubiquitin carboxyl-terminal hydrolase 15 1.887 1.31 2.744 5 KHDRBS1 KH domain-containing. RNA-binding. signal 2.265 1.288 4.013 3 transduction-associated protein 1 STK3 Serine/threonine-protein kinase 3 1.725 1.264 2.336 3 DPYSL3 Dihydropyrimidinase-related protein 3 2.215 1.26 4.311 12 HSP90AB1 Heat shock protein HSP 90-beta 1.878 1.259 2.76 26 SDR16C5 Epidermal retinol dehydrogenase 2 1.943 1.248 3.029 4 DSP Desmoplakin 2.119 1.247 4.138 27 THBS1 Thrombospondin-1 1.682 1.243 2.342 25 SNRPB Small nuclear ribonucleoprotein-associated proteins 1.748 1.236 2.519 10 B and B′ S100A8 Protein S100-A8 1.652 1.222 2.268 10 TUBA1B Tubulin alpha-1B chain 2.971 1.221 7.506 4 AP1M1 AP-1 complex subunit mu-1 1.869 1.215 2.927 3 GSTM1 Glutathione S-transferase Mu 1 2.161 1.214 3.872 2 ACTG1 Actin. cytoplasmic 2 1.666 1.206 2.342 8 THBS2 Thrombospondin-2 1.802 1.188 2.753 10 XRCC6 X-ray repair cross-complementing protein 6 1.605 1.186 2.166 22 GGH Gamma-glutamyl hydrolase 2.392 1.186 5.251 3 SORD Sorbitol dehydrogenase 1.763 1.182 2.657 7 NA Small nuclear ribonucleoprotein G-like protein 1.759 1.181 2.659 2 IGLC2 Ig lambda-2 chain C regions 1.601 1.177 2.151 5 HLA-B HLA class I histocompatibility antigen. B-14 alpha 1.55 1.174 2.05 3 chain MSN Moesin 1.514 1.172 1.974 36 MYO6 Myosin-VI 1.62 1.17 2.26 9 TNC Tenascin 1.616 1.164 2.242 44 AP1B1 AP-1 complex subunit beta-1 1.676 1.155 2.446 10 XYLT2 Xylosyltransferase 2 2.337 1.153 4.893 2 H2AFV Histone H2A.V 1.987 1.15 3.472 2 COTL1 Coactosin-like protein 1.703 1.147 2.54 6 ENAH Protein enabled homolog 1.693 1.146 2.496 4 AKR7A3 Aflatoxin B1 aldehyde reductase member 3 1.832 1.146 2.934 2 CAMK2D Calcium/calmodulin-dependent protein kinase type II 1.793 1.144 2.84 4 subunit delta DBI Acyl-CoA-binding protein 1.606 1.143 2.29 7 LRRC59 Leucine-rich repeat-containing protein 59 1.717 1.141 2.559 7 SMARCA5 SWI/SNF-related matrix-associated actin-dependent 1.544 1.14 2.087 13 regulator of chromatin subfamily A member 5 CFL1 Cofilin-1 1.569 1.136 2.194 18 GUSB Beta-glucuronidase 1.59 1.135 2.215 21 XRCC5 X-ray repair cross-complementing protein 5 1.533 1.133 2.06 24 PSME1 Proteasome activator complex subunit 1 1.536 1.124 2.079 11 CFL2 Cofilin-2 1.713 1.124 2.63 2 TUBB Tubulin beta chain 1.481 1.118 1.973 15 NDRG1 Protein NDRG1 1.554 1.117 2.159 6 HYOU1 Hypoxia up-regulated protein 1 2.287 1.117 5.424 21 ARF4 ADP-ribosylation factor 4 1.606 1.114 2.333 6 TOP2B DNA topoisomerase 2-beta 1.566 1.11 2.232 6 CRABP2 Cellular retinoic acid-binding protein 2 1.617 1.11 2.408 8 PPP4R1 Serine/threonine-protein phosphatase 4 regulatory 1.677 1.108 2.532 3 subunit 1 FABP7 Fatty acid-binding protein. brain 2.98 1.106 10.019 6 SET Protein SET 1.596 1.105 2.318 7 TM9SF3 Transmembrane 9 superfamily member 3 1.66 1.105 2.49 6 SARS Seryl-tRNA synthetase. cytoplasmic 1.519 1.103 2.092 12 DSTN Destrin 1.978 1.101 3.997 6 COPA Coatomer subunit alpha 1.496 1.095 2.068 31 PRKCSH Glucosidase 2 subunit beta 1.603 1.095 2.324 15 UAP1L1 UDP-N-acetylhexosamine pyrophosphorylase-like 1.461 1.094 1.946 4 protein 1 ARF1 ADP-ribosylation factor 1 1.624 1.092 2.396 5 EHD1 EH domain-containing protein 1 1.883 1.091 3.34 6 GBP1 Interferon-induced guanylate-binding protein 1 1.753 1.089 2.823 8 TPM1 Tropomyosin alpha-1 chain 1.516 1.086 2.14 14 NA Ig kappa chain V-III region HAH 1.666 1.084 2.577 4 PPP2R4 Serine/threonine-protein phosphatase 2A activator 1.64 1.08 2.468 3 RAB1A Ras-related protein Rab-1A 1.418 1.078 1.872 6 GSTO1 Glutathione S-transferase omega-1 1.586 1.076 2.316 7 EML4 Echinoderm microtubule-associated protein-like 4 1.8 1.075 3.045 8 PLIN2 Perilipin-2 1.774 1.074 2.931 4 DDT D-dopachrome decarboxylase 1.504 1.072 2.129 5 RAB11A Ras-related protein Rab-11A 1.542 1.072 2.259 2 ERH Enhancer of rudimentary homolog 1.828 1.072 3.166 2 CLIC4 Chloride intracellular channel protein 4 1.803 1.07 3.033 3 MCM6 DNA replication licensing factor MCM6 1.498 1.065 2.126 7 MAPRE1 Microtubule-associated protein RP/EB family 1.575 1.06 2.362 5 member 1 DLD Dihydrolipoyl dehydrogenase. mitochondrial 1.887 1.059 3.951 8 NONO Non-P 1.5 1.057 2.099 24 S100A11 Protein S100-A11 1.613 1.057 2.465 4 SAR1A GTP-binding protein SAR1a 1.529 1.054 2.235 6 EPPK1 Epiplakin 1.423 1.052 1.921 14 MYL12B Myosin regulatory light chain 12B 1.579 1.052 2.347 7 FTL Ferritin light chain 1.743 1.051 3.054 9 SEC14L2 SEC14-like protein 2 1.603 1.048 2.499 5 FKBP4 Peptidyl-prolyl cis-trans isomerase FKBP4 1.46 1.045 2.025 18 ACSL3 Long-chain-fatty-acid--CoA ligase 3 1.38 1.044 1.838 12 MACF1 Microtubule-actin cross-linking factor 1. isoforms 1.539 1.044 2.276 5 1/2/3/5 CALR Calreticulin 1.539 1.04 2.334 21 C22 UPF0027 protein C22orf28 1.336 1.036 1.72 10 RAP1B Ras-related protein Rap-1b 1.496 1.035 2.158 7 ALDOA Fructose-bisphosphate aldolase A 1.37 1.033 1.816 19 PRCC Proline-rich protein PRCC 1.747 1.032 2.985 2 NAPA Alpha-soluble NSF attachment protein 1.585 1.029 2.451 5 PRKDC DNA-dependent protein kinase catalytic subunit 1.276 1.027 1.587 55 ERO1L ER 1.571 1.027 2.441 6 BAZ1B Tyrosine-protein kinase BAZ1B 1.558 1.026 2.371 5 RAD23B UV excision repair protein RAD23 homolog B 1.389 1.025 1.88 7 ISYNA1 Inositol-3-phosphate synthase 1 1.631 1.025 2.6 3 ACTN1 Alpha-actinin-1 2.196 1.025 4.273 25 FBL rRNA 2′- 1.365 1.023 1.846 12 KRT18 Keratin. type I cytoskeletal 18 2.377 1.023 5.583 5 NCF4 Neutrophil cytosol factor 4 1.687 1.021 2.871 4 YWHAZ 14-3-3 protein zeta/delta 1.388 1.02 1.892 13 ECM29 Proteasome-associated protein ECM29 homolog 1.477 1.02 2.169 5 ACTR2 Actin-related protein 2 1.439 1.019 2.037 13 RPLP0 60S acidic ribosomal protein P0 1.527 1.018 2.353 7 RANBP1 Ran-specific GTPase-activating protein 1.554 1.017 2.403 6 GFPT1 Glucosamine--fructose-6-phosphate 1.526 1.016 2.308 9 aminotransferase [isomerizing] 1 PAICS Multifunctional protein ADE2 1.43 1.015 1.996 12 RAN GTP-binding nuclear protein Ran 1.345 1.01 1.77 14 CALD1 Caldesmon 1.434 1.009 2.039 13 CTSB Cathepsin B 1.481 1.009 2.181 7 IMPDH2 Inosine-5′-monophosphate dehydrogenase 2 1.444 1.008 2.09 8 KPNA2 Importin subunit alpha-2 2.048 1.007 3.91 5 RUVBL2 RuvB-like 2 1.345 1.006 1.801 15 CMPK1 UMP-CMP kinase 1.332 1.005 1.758 8 KRT6A Keratin. type II cytoskeletal 6A 1.644 1.005 2.705 3 HTATIP2 Oxidoreductase HTATIP2 1.927 1.005 3.78 2 KRT19 Keratin type I cytoskeletal 19 2.235 1.005 4.978 8 ALDH1A1 Retinal dehydrogenase 1 0.717 0.53 0.971 11 MYO1C Myosin-Ic 0.67 0.527 0.849 18 UAP1 UDP-N-acetylhexosamine pyrophosphorylase 0.701 0.526 0.934 5 CFH Complement factor H 0.693 0.518 0.935 23 KIAA1967 Protein KIAA1967 0.677 0.498 0.909 8 KRT5 Keratin. type II cytoskeletal 5 0.66 0.495 0.875 22 CTNNB1 Catenin beta-1 0.66 0.483 0.902 10 ALDH6A1 Methylmalonate-semialdehyde dehydrogenase 0.686 0.48 0.977 7 [acylating]. mitochondrial EIF2C1 Protein argonaute-1 0.686 0.478 0.983 2 PPP3CB Serine/threonine-protein phosphatase 2B catalytic 0.687 0.469 0.999 2 subunit beta isoform KRT10 Keratin. type I cytoskeletal 10 0.656 0.466 0.927 14 S100A10 Protein S100-A10 0.645 0.461 0.912 8 AHNAK Neuroblast differentiation-associated protein AHNAK 0.606 0.453 0.817 96 TINAGL1 Tubulointerstitial nephritis antigen-like 0.673 0.452 0.982 6 ITGB4 Integrin beta-4 0.594 0.45 0.781 17 F2 Prothrombin 0.602 0.448 0.817 18 APOA1 Apolipoprotein A-I 0.602 0.439 0.831 23 HLA-C HLA class I histocompatibility antigen. Cw-15 alpha 0.571 0.424 0.77 5 chain SERPINF1 Pigment epithelium-derived factor 0.563 0.41 0.772 8 PCOLCE Procollagen C-endopeptidase enhancer 1 0.597 0.408 0.86 7 USP11 Ubiquitin carboxyl-terminal hydrolase 11 0.593 0.406 0.857 5 RAB5B Ras-related protein Rab-5B 0.618 0.398 0.949 4 HDAC1 Histone deacetylase 1 0.591 0.394 0.883 5 CAV1 Caveolin-1 0.623 0.392 0.991 3 PYCRL Pyrroline-5-carboxylate reductase 3 0.613 0.384 0.976 4 EHD2 EH domain-containing protein 2 0.613 0.384 0.985 9 APOH Beta-2-glycoprotein 1 0.602 0.382 0.951 9 HIST1H2BK Histone H2B type 1-K 0.546 0.374 0.812 7 GNB1 Guanine nucleotide-binding protein G(I)/G(S)/G(T) 0.603 0.373 0.952 2 subunit beta-1 KRT16 Keratin. type I cytoskeletal 16 0.566 0.372 0.855 3 UROS Uroporphyrinogen-III synthase 0.568 0.37 0.865 4 AMBP Protein AMBP 0.528 0.368 0.75 6 LRG1 Leucine-rich alpha-2-glycoprotein 0.587 0.362 0.939 3 CP Ceruloplasmin 0.493 0.36 0.69 13 SERPINA4 Kallistatin 0.579 0.359 0.922 4 LIPE Hormone-sensitive lipase 0.59 0.358 0.977 3 METTL7B Methyltransferase-like protein 7B 0.587 0.357 0.959 3 NES Nestin 0.508 0.354 0.73 14 RAB5C Ras-related protein Rab-5C 0.527 0.354 0.781 5 HLA-A HLA class I histocompatibility antigen. A-2 alpha 0.572 0.354 0.921 2 chain LMO7 LIM domain only protein 7 0.558 0.35 0.883 6 CSNK1A1 Casein kinase I isoform alpha 0.596 0.35 0.989 2 WDR36 WD repeat-containing protein 36 0.581 0.344 0.963 3 SFRP1 Secreted frizzled-related protein 1 0.523 0.333 0.82 4 CBX5 Chromobox protein homolog 5 0.552 0.332 0.919 2 AFM Afamin 0.532 0.33 0.863 5 KNG1 Kininogen-1 0.514 0.327 0.822 10 APOA2 Apolipoprotein A-II 0.556 0.313 0.974 3 GSTM3 Glutathione S-transferase Mu 3 0.523 0.312 0.867 3 PCCB Propionyl-CoA carboxylase beta chain. 0.528 0.309 0.904 2 mitochondrial ACOT2 Acyl-coenzyme A thioesterase 2. mitochondrial 0.494 0.308 0.773 3 LBP Lipopolysaccharide-binding protein 0.52 0.303 0.89 3 APOA4 Apolipoprotein A-IV 0.458 0.302 0.687 9 ABI3BP Target of Nesh-SH3 0.508 0.295 0.869 4 PLIN1 Perilipin-1 0.437 0.293 0.659 8 CAST Calpastatin 0.496 0.29 0.823 5 TNXB Tenascin-X 0.448 0.286 0.696 8 ORM1 Alpha-1-acid glycoprotein 1 0.446 0.281 0.715 7 HIST2H2AC Histone H2A type 2-C 0.391 0.279 0.546 4 OLFML3 Olfactomedin-like 3 0.437 0.278 0.68 4 CLEC3B Tetranectin 0.462 0.27 0.799 4 COL4A1 Collagen alpha-1(IV) chain 0.481 0.269 0.88 3 IGLC1 Ig lambda-1 chain C regions 0.42 0.267 0.656 2 GC Vitamin D-binding protein 0.462 0.265 0.804 12 PIGR Polymeric immunoglobulin receptor 0.488 0.265 0.836 6 KRT1 Keratin. type II cytoskeletal 1 0.453 0.26 0.788 5 PTRF Polymerase I and transcript release factor 0.441 0.253 0.749 6 OLFML1 Olfactomedin-like 1 0.45 0.249 0.82 2 AGR2 Anterior gradient protein 2 homolog 0.413 0.241 0.699 6 MYH11 Myosin-11 0.354 0.234 0.526 13 MFAP4 Microfibril-associated glycoprotein 4 0.402 0.232 0.688 2 CMA1 Chymase 0.363 0.229 0.591 8 TTR Transthyretin 0.327 0.224 0.482 7 CFD Complement factor D 0.38 0.214 0.663 2 SOD3 Extracellular superoxide dismutase [Cu—Zn] 0.368 0.197 0.687 3 HIST3H2A Histone H2A type 3 0.289 0.193 0.433 2 COL6A6 Collagen alpha-6(VI) chain 0.38 0.183 0.823 9 AOC3 Membrane primary amine oxidase 0.335 0.179 0.616 11 ATL2 Atlastin-2 0.419 0.176 0.942 2 SERPIND1 Heparin cofactor 2 0.363 0.167 0.79 2 DPT Dermatopontin 0.282 0.144 0.534 7 TPSAB1 Tryptase alpha-1 0.356 0.139 0.831 2 ADH1C Alcohol dehydrogenase 1C 0.27 0.131 0.533 2 AZGP1 Zinc-alpha-2-glycoprotein 0.172 0.123 0.239 16 OGN Mimecan 0.144 0.104 0.196 15 DCN Decorin 0.503 0.1 0.75 19 ELN Elastin 0.141 0.074 0.271 4 IGHA2 Ig alpha-2 chain C region 0.121 0.054 0.313 8 APOD Apolipoprotein D 0.065 0.043 0.099 10 LGALS4 Galectin-4 0.077 0.035 0.174 3 PIP Prolactin-inducible protein 0.096 0.031 0.289 5 IGJ Immunoglobulin J chain 0.077 0.027 0.214 2 DES Desmin 0.038 0.019 0.079 3

TABLE 6B Gene ontology (GO) molecular function - triple-negative breast cancer Molecular functions pValue Ratio 1 protein binding 8.478e−25 193/8829 2 MHC class I receptor activity 3.771e−19 14/31  3 binding 9.638e−17  232/13778 4 GTPase activity 2.003e−13 23/257 5 polysaccharide binding 2.689e−11 20/239 6 pattern binding 2.689e−11 20/239 7 glycosaminoglycan binding 3.064e−11 19/214 8 nucleoside-triphosphatase activity 3.074e−11 37/840 9 heparin binding 3.601e−11 17/166 10 small molecule binding 4.286e−11  75/2773 11 receptor binding 6.439e−11  51/1506 12 GTP binding 7.220e−11 25/407 13 carbohydrate binding 8.160e−11 28/514 14 pyrophosphatase activity 1.081e−10 37/878 15 hydrolase activity, acting on acid 1.190e−10 37/881 anhydrides, in phosphorus-containing anhydrides 16 hydrolase activity, acting on acid 1.268e−10 37/883 anhydrides 17 guanyl nucleotide binding 1.631e−10 25/423 18 guanyl ribonucleotide binding 1.631e−10 25/423 19 structural molecule activity 2.884e−10 32/699 20 purine ribonucleoside triphosphate binding 1.339e−9  57/1960 21 purine ribonucleotide binding 2.570e−9  57/1995 22 ribonucleotide binding 2.617e−9  57/1996 23 structural constituent of cytoskeleton 2.943e−9 12/96  24 nucleotide binding 3.295e−9  67/2573 25 nucleoside phosphate binding 3.348e−9  67/2574 26 purine nucleotide binding 3.440e−9  57/2011 27 actin binding 1.710e−8 21/381 28 cytoskeletal protein binding 2.807e−7 27/703 29 catalytic activity 4.501e−7 114/6069 30 hydrolase activity 1.013e−6  62/2676 31 protein complex binding 5.122e−6 20/496 32 phosphatidylcholine-sterol 1.922e−5 03/05  O-acyltransferase activator activity 33 cholesterol binding 2.334e−5 05/28  34 glutathione transferase activity 5.354e−5 05/33  35 identical protein binding 5.658e−5 28/992 36 ATP binding 9.852e−5  38/1592 37 opsonin binding 1.047e−4 03/08  38 sterol binding 1.076e−4 05/38  39 collagen binding 1.154e−4 06/61  40 peptidase regulator activity 1.202e−4 13/301 41 adenyl ribonucleotide binding 1.428e−4  38/1621 42 transferase activity, transferring alkyl or 1.510e−4 06/64  aryl (other than methyl) groups 43 intermediate filament binding 1.556e−4 03/09  44 rRNA primary transcript binding 1.571e−4 02/02  45 D-dopachrome decarboxylase activity 1.571e−4 02/02  46 adenyl nucleotide binding 1.679e−4  38/1634 47 microfilament motor activity 2.120e−4 04/24  48 steroid binding 2.381e−4 07/98  49 extracellular matrix binding 2.438e−4 05/45  50 cysteine-type endopeptidase inhibitor 2.481e−4 06/70  activity

TABLE 6C Gene ontology (GO) process - triple-negative breast cancer Process networks pValue Ratio 1 Cytoskeleton_Intermediate filaments 9.295e−16 21/81  2 Cell adhesion_Integrin-mediated cell-matrix 8.568e−9 23/214 adhesion 3 Cell adhesion_Cell junctions 4.510e−8 19/162 4 Cytoskeleton_Regulation of cytoskeleton 6.496e−8 20/183 rearrangement 5 Immune response_Phagosome in antigen 4.017e−7 22/243 presentation 6 Protein folding_Protein folding nucleus 2.395e−6 10/58  7 Cytoskeleton_Actin filaments 3.764e−6 17/176 8 Protein folding_ER and cytoplasm 1.997e−5 08/45  9 Immune response_Antigen presentation 6.401e−5 16/197 10 Cell cycle_Mitosis 7.642e−5 15/179

TABLE 6D Enrichment by protein function - triple-negative breast cancer Percentage Protein In In function Protein data protein in class Actual n R N Expected Ratio p-value z-score set function database Ligands 14 271 514 23844 5.842 2.396 2.400E−03 3.432 5.17% 2.72% 2.16% Proteases 10 271 559 23844 6.353 1.574 1.066E−01 1.472 3.69% 1.79% 2.34% Enzymes 48 271 2724 23844 30.96 1.55 1.353E−03 3.273 17.71% 1.76% 11.42% Kinases 10 271 654 23844 7.433 1.345 2.125E−01 0.9602 3.69% 1.53% 2.74% Phosphatases 3 271 230 23844 2.614 1.148 4.867E−01 0.2412 1.11% 1.30% 0.96% Receptors 18 271 1565 23844 17.79 1.012 5.143E−01 0.05253 6.64% 1.15% 6.56% Transcription 4 271 959 23844 10.9 0.367 1.428E−02 −2.145 1.48% 0.42% 4.02% factors Other 164 271 16691 23844 189.7 0.8645 5.086E−04 −3.427 60.52% 0.98% 70.00%

2.2. A Proteomic Coverage of the Different Status

The inventors used the iQuantitator software to quantify protein expression between the different status “relapse” and “no relapse”. For the “relapse” group, 295 proteins were significantly differentially expressed: 165 were overexpressed and 130 were underexpressed (Table 7A). The Metacore analysis of this list of proteins indicated a cytoskeleton remodeling with a pValue=9.2 10-12 for the Process Network “Regulation of Cytoskeleton Rearrangement” and a best enrichment score and p-value for “Binding” (p=9.4 10-26) in the GO Molecular Functions term. It should be noted that 26 ligands were found in this list characterizing the “Relapse” group (Table 7D).

TABLE 7A Proteins underexpressed and overexpressed in recurrence of triple-negative breast cancer Confidence intervals Peptide Gene Protein Mean min max number CYP2A6 Cytochrome P450 2A6 5.532 3.695 8.322 7 ALOX15B Arachidonate 15-lipoxygenase B 5.031 3.61 7.064 10 SDR16C5 Epidermal retinol dehydrogenase 2 5.394 3.079 9.449 4 HLA-A HLA class I histocompatibility antigen. A-33 alpha 3.504 2.388 5.128 4 chain GUSB Beta-glucuronidase 2.962 2.209 3.971 18 S100A7 Protein S100-A7 2.952 1.93 4.509 2 HPGD 15-hydroxyprostaglandin dehydrogenase [NAD+] 2.917 1.896 4.542 5 DHRS2 Dehydrogenase/reductase SDR family member 2 3.134 1.885 5.283 7 FKBP5 Peptidyl-prolyl cis-trans isomerase FKBP5 3.329 1.822 6.087 6 ACSL3 Long-chain-fatty-acid--CoA ligase 3 2.536 1.803 3.581 12 NAMPT Nicotinamide phosphoribosyltransferase 2.566 1.788 3.695 11 KRT8 Keratin type II cytoskeletal 8 2.782 1.678 4.622 14 EEF1A1 Elongation factor 1-alpha 1 2.348 1.674 3.317 12 NA Small nuclear ribonucleoprotein G-like protein 2.505 1.669 3.818 2 DBI Acyl-CoA-binding protein 2.266 1.595 3.249 6 SCP2 Non-specific lipid-transfer protein 2.129 1.571 2.881 10 MDH2 Malate dehydrogenase. mitochondrial 2.226 1.567 3.166 11 CALR Calreticulin 1.998 1.564 2.531 21 TM9SF3 Transmembrane 9 superfamily member 3 2.576 1.538 4.319 5 UAP1L1 UDP-N-acetylhexosamine pyrophosphorylase-like 2.268 1.529 3.401 3 protein 1 SNRPB Small nuclear ribonucleoprotein-associated proteins 2.079 1.517 2.834 10 B and B′ SEC14L2 SEC14-like protein 2 2.471 1.476 4.225 4 YBX1 Nuclease-sensitive element-binding protein 1 2.086 1.464 3.001 6 IPO9 Importin-9 2.527 1.42 4.424 3 KPNB1 Importin subunit beta-1 2.1 1.409 3.081 10 HLA-B HLA class I histocompatibility antigen. B-14 alpha 2.154 1.386 3.375 3 chain MCCC2 Methylcrotonoyl-CoA carboxylase beta chain. 1.905 1.377 2.66 12 mitochondrial RAB5A Ras-related protein Rab-5A 2.185 1.366 3.557 3 TPM3 Tropomyosin alpha-3 chain 2.182 1.344 3.648 7 AKR1C2 Aldo-keto reductase family 1 member C2 2.442 1.337 4.435 5 IDI1 Isopentenyl-diphosphate Delta-isomerase 1 2.071 1.335 3.198 6 CNN2 Calponin-2 2.131 1.335 3.388 4 GOT1 Aspartate aminotransferase. cytoplasmic 1.983 1.33 2.99 7 THBS1 Thrombospondin-1 1.728 1.316 2.285 23 DPYSL3 Dihydropyrimidinase-related protein 3 1.892 1.313 2.712 12 DSP Desmoplakin 1.818 1.311 2.531 25 CRABP2 Cellular retinoic acid-binding protein 2 1.923 1.31 2.816 8 HSP90AB1 Heat shock protein HSP 90-beta 1.927 1.309 2.921 25 KPNA2 Importin subunit alpha-2 2.158 1.308 3.501 5 DDT D-dopachrome decarboxylase 2.116 1.301 3.485 5 IDH2 Isocitrate dehydrogenase [NADP]. mitochondrial 1.733 1.299 2.304 20 G6PD Glucose-6-phosphate 1-dehydrogenase 1.751 1.298 2.376 18 S100A11 Protein S100-A11 2.031 1.289 3.176 3 PLIN2 Perilipin-2 2.216 1.288 3.846 4 GPI Glucose-6-phosphate isomerase 1.739 1.277 2.349 16 NME2 Nucleoside diphosphate kinase B 1.678 1.268 2.215 11 NDRG1 Protein NDRG1 1.838 1.268 2.663 5 ALCAM CD166 antigen 1.865 1.255 2.789 7 ITGAM Integrin alpha-M 2.019 1.246 3.283 5 FTL Ferritin light chain 1.892 1.24 3.011 9 IPO5 Importin-5 1.9 1.238 2.936 8 TUBA1C Tubulin alpha-1C chain 1.752 1.236 2.503 4 SORD Sorbitol dehydrogenase 2.005 1.227 3.329 4 USP15 Ubiquitin carboxyl-terminal hydrolase 15 1.931 1.209 3.115 3 TOP2B DNA topoisomerase 2-beta 1.671 1.206 2.333 6 FKBP4 Peptidyl-prolyl cis-trans isomerase FKBP4 1.715 1.193 2.489 18 AKR1B15 Putative aldo-keto reductase family 1 member B15 1.969 1.193 3.263 3 SAR1A GTP-binding protein SAR1a 1.725 1.184 2.498 5 STK3 Serine/threonine-protein kinase 3 1.746 1.184 2.563 2 CFL2 Cofilin-2 1.673 1.181 2.4 2 PPA2 Inorganic pyrophosphatase 2. mitochondrial 2.403 1.179 4.955 2 AP1M2 AP-1 complex subunit mu-2 1.778 1.178 2.732 4 KRT7 Keratin. type II cytoskeletal 7 2.271 1.178 4.914 26 SET Protein SET 1.678 1.175 2.438 6 PPP2R4 Serine/threonine-protein phosphatase 2A activator 1.969 1.171 3.321 2 PRKCSH Glucosidase 2 subunit beta 1.592 1.167 2.18 15 XRCC5 X-ray repair cross-complementing protein 5 1.502 1.164 1.936 23 CALD1 Caldesmon 1.676 1.158 2.426 12 ENAH Protein enabled homolog 1.911 1.158 3.183 3 ACOX1 Peroxisomal acyl-coenzyme A oxidase 1 1.774 1.156 2.804 7 CRAT Carnitine 1.862 1.156 3.019 4 THBS2 Thrombospondin-2 1.628 1.148 2.323 10 EEF1D Elongation factor 1-delta 1.631 1.147 2.356 10 DHCR24 24-dehydrocholesterol reductase 1.936 1.146 3.379 3 MSN Moesin 1.412 1.145 1.724 35 H2AFV Histone H2A.V 1.995 1.142 3.485 2 PPP4R1 Serine/threonine-protein phosphatase 4 regulatory 1.888 1.14 3.209 2 subunit 1 CRABP1 Cellular retinoic acid-binding protein 1 1.677 1.137 2.467 7 S100A8 Protein S100-A8 1.522 1.134 2.046 9 ATP6V1A V-type proton ATPase catalytic subunit A 1.551 1.133 2.128 10 TMED7 Transmembrane emp24 domain-containing protein 7 2.07 1.126 3.85 3 ARF4 ADP-ribosylation factor 4 1.692 1.123 2.576 6 TKT Transketolase 1.584 1.122 2.208 21 PSME1 Proteasome activator complex subunit 1 1.519 1.118 2.057 11 TNC Tenascin 1.574 1.116 2.269 44 NQO1 NAD(P)H dehydrogenase [quinone] 1 1.542 1.108 2.152 6 SOD1 Superoxide dismutase [Cu—Zn] 1.615 1.108 2.347 6 CAMK2D Calcium/calmodulin-dependent protein kinase type II 1.739 1.108 2.769 4 subunit delta MAPK13 Mitogen-activated protein kinase 13 1.942 1.107 3.547 2 FASN Fatty acid synthase 1.563 1.106 2.223 56 HSD17B11 Estradiol 17-beta-dehydrogenase 11 2.016 1.106 3.671 4 RAB1A Ras-related protein Rab-1A 1.551 1.099 2.203 5 NAPA Alpha-soluble NSF attachment protein 1.752 1.099 2.864 5 CDK1 Cell division protein kinase 1 1.92 1.099 3.38 3 C1S Complement C1s subcomponent 2.216 1.099 4.614 4 TUBB Tubulin beta chain 1.463 1.098 1.942 15 FAH Fumarylacetoacetase 1.953 1.097 3.452 3 SEC23B Protein transport protein Sec23B 1.497 1.092 2.062 10 IMPDH2 Inosine-5′-monophosphate dehydrogenase 2 1.596 1.088 2.341 8 RAP1B Ras-related protein Rap-1b 1.46 1.083 1.972 7 ECM29 Proteasome-associated protein ECM29 homolog 1.611 1.081 2.401 5 TUBA1B Tubulin alpha-1B chain 1.604 1.08 2.415 3 SMARCA5 SWI/SNF-related matrix-associated actin-dependent 1.458 1.077 1.981 12 regulator of chromatin subfamily A member 5 SQRDL Sulfide:quinone oxidoreductase. mitochondrial 1.415 1.076 1.861 14 PMVK Phosphomevalonate kinase 1.549 1.075 2.239 8 MYO6 Myosin-VI 1.634 1.074 2.472 9 IARS Isoleucyl-tRNA synthetase. cytoplasmic 1.458 1.073 2.004 14 NDUFS8 NADH dehydrogenase [ubiquinone] iron-sulfur 1.671 1.072 2.652 2 protein 8. mitochondrial RBM25 RNA-binding protein 25 1.627 1.07 2.479 3 MCM6 DNA replication licensing factor MCM6 1.488 1.069 2.085 7 PTGES3 Prostaglandin E synthase 3 1.56 1.067 2.304 5 GGH Gamma-glutamyl hydrolase 1.775 1.067 2.933 3 COPE Coatomer subunit epsilon 1.589 1.066 2.37 5 PRKDC DNA-dependent protein kinase catalytic subunit 1.279 1.063 1.537 55 GLO1 Lactoylglutathione lyase 1.477 1.062 2.062 6 IDH1 Isocitrate dehydrogenase [NADP] cytoplasmic 1.483 1.06 2.085 11 GSTO1 Glutathione S-transferase omega-1 1.54 1.059 2.244 7 CSE1L Exportin-2 1.588 1.059 2.381 7 PPA1 Inorganic pyrophosphatase 1.518 1.056 2.194 8 SSBP1 Single-stranded DNA-binding protein. mitochondrial 1.467 1.055 2.041 8 PTBP1 Polypyrimidine tract-binding protein 1 1.472 1.052 2.1 14 CCT7 T-complex protein 1 subunit eta 1.528 1.051 2.267 17 RPL8 60S ribosomal protein L8 1.475 1.05 2.087 13 GOLGB1 Golgin subfamily B member 1 1.674 1.05 2.662 3 PPP3CA Serine/threonine-protein phosphatase 2B catalytic 1.672 1.05 2.685 2 subunit alpha isoform GFPT1 Glucosamine--fructose-6-phosphate 1.629 1.049 2.499 8 aminotransferase [isomerizing] 1 SFRS1 Splicing factor. arginine/serine-rich 1 1.569 1.047 2.373 8 SOD2 Superoxide dismutase [Mn]. mitochondrial 1.545 1.046 2.277 5 PGRMC1 Membrane-associated progesterone receptor 1.662 1.041 2.592 3 component 1 DERL1 Derlin-1 1.902 1.041 3.49 2 SERBP1 Plasminogen activator inhibitor 1 RNA-binding 1.512 1.04 2.211 9 protein CANX Calnexin 1.416 1.039 1.942 18 PPIB Peptidyl-prolyl cis-trans isomerase B 1.499 1.038 2.186 17 PEPD Xaa-Pro dipeptidase 1.842 1.038 3.357 2 SARS Seryl-tRNA synthetase. cytoplasmic 1.405 1.037 1.914 11 CALU Calumenin 1.45 1.035 2.015 8 STAT3 Signal transducer and activator of transcription 3 1.482 1.034 2.126 8 UGDH UDP-glucose 6-dehydrogenase 1.358 1.033 1.779 17 POR NADPH--cytochrome P450 reductase 1.392 1.033 1.859 9 ISYNA1 Inositol-3-phosphate synthase 1 1.739 1.032 2.962 3 DNASE2 Deoxyribonuclease-2-alpha 2.018 1.03 3.973 2 CLIC4 Chloride intracellular channel protein 4 1.781 1.029 3.075 3 PGAM1 Phosphoglycerate mutase 1 1.374 1.026 1.866 15 EIF2C2 Protein argonaute-2 1.474 1.024 2.108 3 KRT18 Keratin. type I cytoskeletal 18 2.195 1.024 4.949 5 DPP3 Dipeptidyl peptidase 3 1.514 1.023 2.236 11 RAP2B Ras-related protein Rap-2b 1.719 1.023 2.872 3 PAICS Multifunctional protein ADE2 1.366 1.021 1.825 12 RAN GTP-binding nuclear protein Ran 1.304 1.02 1.678 14 EPPK1 Epiplakin 1.44 1.015 2.047 13 DDB1 DNA damage-binding protein 1 1.487 1.015 2.203 10 KRT19 Keratin type I cytoskeletal 19 2.044 1.013 4.534 8 NONO Non-P 1.259 1.012 1.584 23 SERPINH1 Serpin H1 1.272 1.011 1.59 20 RPL35 60S ribosomal protein L35 1.521 1.01 2.291 6 CALML5 Calmodulin-like protein 5 1.554 1.009 2.377 7 HIST1H1C Histone H1.2 1.468 1.008 2.12 9 NUDT3 Diphosphoinositol polyphosphate phosphohydrolase 1 1.639 1.008 2.662 3 TES Testin 1.669 1.008 2.833 5 EIF4A1 Eukaryotic initiation factor 4A-I 1.366 1.007 1.83 14 SLC25A6 ADP/ATP translocase 3 1.65 1.006 2.667 4 LRRC59 Leucine-rich repeat-containing protein 59 1.489 1.003 2.217 7 IL4I1 L-amino-acid oxidase 1.507 1 2.243 3 ERH Enhancer of rudimentary homolog 1.863 1 3.455 2 LMNA Prelamin-A/C 0.8 0.662 0.966 26 AHNAK Neuroblast differentiation-associated protein AHNAK 0.671 0.578 0.779 96 SPTAN1 Spectrin alpha chain. brain 0.711 0.577 0.874 58 ACADVL Very long-chain specific acyl-CoA dehydrogenase. 0.736 0.546 0.992 12 mitochondrial HSPG2 Basement membrane-specific heparan sulfate 0.67 0.535 0.842 53 proteoglycan core protein UBC Polyubiquitin-C 0.696 0.524 0.923 5 RBM39 RNA-binding protein 39 0.7 0.516 0.949 7 CFH Complement factor H 0.642 0.512 0.808 23 SPTBN1 Spectrin beta chain. brain 1 0.635 0.505 0.797 34 HIST1H2BL Histone H2B type 1-L 0.669 0.501 0.911 8 ITGB4 Integrin beta-4 0.661 0.498 0.875 17 KRT10 Keratin. type I cytoskeletal 10 0.676 0.493 0.934 14 RAB1B Ras-related protein Rab-1B 0.674 0.483 0.941 6 SELENBP1 Selenium-binding protein 1 0.639 0.479 0.853 12 NA Ras-related protein Rap-1b-like protein 0.67 0.471 0.959 2 KIAA1967 Protein KIAA1967 0.664 0.47 0.941 7 CAD CAD protein 0.666 0.467 0.966 12 MAGOHB Protein mago nashi homolog 2 0.669 0.463 0.973 4 APCS Serum amyloid P-component 0.659 0.461 0.941 6 UTRN Utrophin 0.677 0.46 0.987 6 NES Nestin 0.589 0.457 0.753 14 APOB Apolipoprotein B-100 0.603 0.45 0.808 19 ASPN Asporin 0.657 0.435 0.976 16 CTNNB1 Catenin beta-1 0.602 0.427 0.852 10 LAMA5 Laminin subunit alpha-5 0.605 0.424 0.87 7 HRG Histidine-rich glycoprotein 0.637 0.424 0.977 11 S100A10 Protein S100-A10 0.592 0.423 0.818 7 TST Thiosulfate sulfurtransferase 0.622 0.422 0.926 8 CNN1 Calponin-1 0.636 0.413 0.983 3 CES1 Liver carboxylesterase 1 0.625 0.409 0.943 6 IGLC6 Ig lambda-6 chain C region 0.61 0.404 0.899 2 LAMB2 Laminin subunit beta-2 0.562 0.403 0.79 6 LRG1 Leucine-rich alpha-2-glycoprotein 0.619 0.402 0.935 3 EIF2C1 Protein argonaute-1 0.609 0.401 0.93 2 MYO1C Myosin-Ic 0.553 0.4 0.767 18 F13A1 Coagulation factor XIII A chain 0.542 0.398 0.737 11 APOH Beta-2-glycoprotein 1 0.59 0.398 0.871 9 CAST Calpastatin 0.607 0.396 0.935 5 SLC4A1 Band 3 anion transport protein 0.618 0.395 0.964 5 SUCLG2 Succinyl-CoA ligase [GDP-forming] subunit beta. 0.62 0.395 0.965 4 mitochondrial F2 Prothrombin 0.512 0.391 0.667 17 USP11 Ubiquitin carboxyl-terminal hydrolase 11 0.597 0.391 0.906 3 AMBP Protein AMBP 0.555 0.388 0.801 6 NID1 Nidogen-1 0.559 0.387 0.797 9 CCDC22 Coiled-coil domain-containing protein 22 0.618 0.387 0.975 4 DDX60 Probable ATP-dependent RNA helicase DDX60 0.617 0.382 0.976 2 HDAC1 Histone deacetylase 1 0.584 0.378 0.905 5 FABP4 Fatty acid-binding protein. adipocyte 0.602 0.374 0.972 7 ALG5 Dolichyl-phosphate beta-glucosyltransferase 0.604 0.369 0.976 3 LMO7 LIM domain only protein 7 0.568 0.368 0.877 6 HPDL 4-hydroxyphenylpyruvate dioxygenase-like protein 0.595 0.364 0.966 5 CAMK2B Calcium/calmodulin-dependent protein kinase type II 0.596 0.364 0.981 2 subunit beta KRT15 Keratin. type I cytoskeletal 15 0.558 0.363 0.855 8 GSTM3 Glutathione S-transferase Mu 3 0.593 0.362 0.963 3 SERPING1 Plasma protease C1 inhibitor 0.525 0.359 0.766 7 PCOLCE Procollagen C-endopeptidase enhancer 1 0.551 0.355 0.867 7 SERPINA4 Kallistatin 0.562 0.355 0.885 4 SERPINF1 Pigment epithelium-derived factor 0.513 0.353 0.735 8 OLFML3 Olfactomedin-like 3 0.537 0.35 0.819 4 CP Ceruloplasmin 0.473 0.346 0.643 13 ACTB Actin. cytoplasmic 1 0.481 0.343 0.675 8 WDR36 WD repeat-containing protein 36 0.565 0.336 0.947 2 METTL7B Methyltransferase-like protein 7B 0.567 0.335 0.952 3 LBP Lipopolysaccharide-binding protein 0.57 0.333 0.978 3 MRPL13 39S ribosomal protein L13. mitochondrial 0.559 0.332 0.928 2 S100B Protein S100-B 0.562 0.331 0.95 2 APOA1 Apolipoprotein A-I 0.422 0.327 0.549 23 TINAGL1 Tubulointerstitial nephritis antigen-like 0.492 0.324 0.756 5 ACOT2 Acyl-coenzyme A thioesterase 2. mitochondrial 0.518 0.324 0.818 3 GNB1 Guanine nucleotide-binding protein G(I)/G(S)/G(T) 0.553 0.324 0.927 2 subunit beta-1 PCCB Propionyl-CoA carboxylase beta chain. mitochondrial 0.558 0.324 0.95 2 CTSG Cathepsin G 0.522 0.323 0.86 3 CSNK1A1 Casein kinase I isoform alpha 0.561 0.322 0.963 2 CFD Complement factor D 0.554 0.317 0.951 2 SAP30BP SAP30-binding protein 0.567 0.317 0.996 2 KNG1 Kininogen-1 0.508 0.307 0.857 10 APOA2 Apolipoprotein A-II 0.5 0.294 0.853 3 UAP1 UDP-N-acetylhexosamine pyrophosphorylase 0.435 0.288 0.654 4 PLS1 Plastin-1 0.517 0.285 0.911 2 ARF3 ADP-ribosylation factor 3 0.483 0.284 0.831 3 MYO1G Myosin-Ig 0.519 0.281 0.937 3 AFM Afamin 0.482 0.276 0.838 5 RAB5C Ras-related protein Rab-5C 0.418 0.275 0.632 4 APOA4 Apolipoprotein A-IV 0.387 0.271 0.55 9 PTRF Polymerase I and transcript release factor 0.415 0.269 0.645 6 CPB1 Carboxypeptidase B 0.391 0.268 0.571 5 CD36 Platelet glycoprotein 4 0.476 0.267 0.841 2 ORM1 Alpha-1-acid glycoprotein 1 0.405 0.265 0.625 7 SFRP1 Secreted frizzled-related protein 1 0.418 0.254 0.676 3 CLEC3B Tetranectin 0.434 0.251 0.75 3 TUBGCP2 Gamma-tubulin complex component 2 0.497 0.25 0.976 2 EHD2 EH domain-containing protein 2 0.352 0.247 0.506 9 HLA-C HLA class I histocompatibility antigen. Cw-15 alpha 0.387 0.247 0.601 5 chain PLIN4 Perilipin-4 0.45 0.244 0.84 3 GC Vitamin D-binding protein 0.436 0.234 0.838 11 AGR2 Anterior gradient protein 2 homolog 0.385 0.231 0.641 6 CMA1 Chymase 0.312 0.221 0.446 8 PIGR Polymeric immunoglobulin receptor 0.339 0.218 0.531 6 PLIN1 Perilipin-1 0.343 0.218 0.543 8 OLFML1 Olfactomedin-like 1 0.399 0.217 0.739 2 ATL2 Atlastin-2 0.455 0.215 0.89 2 ABI3BP Target of Nesh-SH3 0.404 0.212 0.75 3 PRELP Prolargin 0.32 0.192 0.57 16 HP Haptoglobin 0.275 0.191 0.396 16 CPA3 Mast cell carboxypeptidase A 0.309 0.189 0.507 4 MYH11 Myosin-11 0.262 0.179 0.382 13 TNXB Tenascin-X 0.301 0.179 0.497 6 HIST2H2AC Histone H2A type 2-C 0.259 0.177 0.376 4 LTF Lactotransferrin 0.243 0.164 0.359 41 AOC3 Membrane primary amine oxidase 0.232 0.161 0.328 11 DPT Dermatopontin 0.253 0.161 0.397 7 TTR Transthyretin 0.271 0.159 0.466 6 ORM2 Alpha-1-acid glycoprotein 2 0.276 0.154 0.505 3 TPSAB1 Tryptase alpha-1 0.284 0.153 0.52 2 HIST3H2A Histone H2A type 3 0.241 0.149 0.386 2 AZGP1 Zinc-alpha-2-glycoprotein 0.192 0.133 0.276 15 SOD3 Extracellular superoxide dismutase [Cu—Zn] 0.227 0.132 0.391 3 COL6A6 Collagen alpha-6(VI) chain 0.257 0.132 0.483 9 IGHA2 Ig alpha-2 chain C region 0.23 0.128 0.415 8 MFAP4 Microfibril-associated glycoprotein 4 0.231 0.121 0.433 2 OGN Mimecan 0.135 0.102 0.178 15 IGHA1 Ig alpha-1 chain C region 0.112 0.081 0.152 14 ELN Elastin 0.141 0.08 0.248 4 APOD Apolipoprotein D 0.107 0.075 0.152 10 DCN Decorin 0.103 0.07 0.153 19 LGALS4 Galectin-4 0.106 0.059 0.191 3 IGJ Immunoglobulin J chain 0.122 0.049 0.291 2 PIP Prolactin-inducible protein 0.077 0.039 0.152 5 DES Desmin 0.03 0.017 0.051 3 ARHGAP1 Rho GTPase-activating protein 1 1.289 1.002 1.716 8

TABLE 7B Gene Ontology (GO) molecular function - recurrence of triple-negative breast cancer Molecular functions pValue Ratio 1 binding 9.410e−26  324/13778 2 protein binding 5.514e−25 249/8829 3 MHC class I receptor activity 3.277e−17 14/31  4 glycosaminoglycan binding 4.145e−13 24/214 5 polysaccharide binding 6.496e−13 25/239 6 pattern binding 6.496e−13 25/239 7 carbohydrate binding 1.109e−12 36/514 8 heparin binding 1.190e−12 21/166 9 structural molecule activity 8.422e−12 41/699 10 small molecule binding 1.884e−11  95/2773 11 catalytic activity 2.085e−11 164/6069 12 oxidoreductase activity, acting on the 3.350e−11 18/139 CH—OH group of donors, NAD or NADP as acceptor 13 oxidoreductase activity, acting on 1.883e−10 18/154 CH—OH group of donors 14 receptor binding 3.434e−10  61/1506 15 nucleotide binding 4.193e−9  84/2573 16 nucleoside phosphate binding 4.270e−9  84/2574 17 collagen binding 6.695e−9 11/61  18 isomerase activity 1.890e−8 16/160 19 hydrolase activity 1.140e−7  82/2676 20 GTPase activity 1.211e−7 19/257 21 actin binding 2.305e−7 23/381 22 superoxide dismutase activity 4.297e−7 04/05  23 oxidoreductase activity, acting on 4.297e−7 04/05  superoxide radicals as acceptor 24 oxidoreductase activity 5.270e−7 36/839 25 GTP binding 7.314e−7 23/407 26 structural constituent of cytoskeleton 8.242e−7 11/96  27 guanyl nucleotide binding 1.416e−6 23/423 28 guanyl ribonucleotide binding 1.416e−6 23/423 29 pyrophosphatase activity 1.521e−6 36/878 30 hydrolase activity, acting on acid 1.645e−6 36/881 anhydrides, in phosphorus-containing anhydrides 31 hydrolase activity, acting on acid 1.733e−6 36/883 anhydrides 32 purine ribonucleoside triphosphate binding 2.038e−6  62/1960 33 calmodulin binding 2.914e−6 14/179 34 purine ribonucleotide binding 3.624e−6  62/1995 35 ribonucleotide binding 3.683e−6  62/1996 36 purine nucleotide binding 4.683e−6  62/2011 37 cytoskeletal protein binding 5.434e−6 30/703 38 monocarboxylic acid binding 5.647e−6 09/75  39 coenzyme binding 6.287e−6 15/218 40 high-density lipoprotein particle binding 1.025e−5 04/09  41 nucleoside-triphosphatase activity 1.032e−5 33/840 42 extracellular matrix binding 1.108e−5 07/45  43 cofactor binding 2.797e−5 17/308 44 intramolecular oxidoreductase activity 2.944e−5 07/52  45 phosphatidylcholine-sterol 4.962e−5 03/05  O-acyltransferase activator activity 46 steroid binding 4.998e−5 09/98  47 carboxylic acid binding 7.754e−5 13/210 48 lipoprotein particle binding 8.777e−5 05/27  49 protein-lipid complex binding 8.777e−5 05/27  50 cholesterol transporter activity 1.023e−4 04/15 

TABLE 7C Gene Ontology (GO) process - recurrence of triple-negative breast cancer Networks pValue Ratio 1 Cytoskeleton_Intermediate filaments 9.234e−12 19/81  2 Cytoskeleton_Regulation of cytoskeleton 1.330e−7 22/183 rearrangement 3 Cell adhesion_Integrin-mediated cell-matrix 7.312e−6 21/214 adhesion 4 Immune response_Phagosome in antigen 1.609e−5 22/243 presentation 5 Cytoskeleton_Actin filaments 1.919e−5 18/176 6 Cell cycle_Mitosis 2.418e−5 18/179 7 Cell adhesion_Cell-matrix interactions 2.075e−4 18/211 8 Immune response_Antigen presentation 2.719e−4 17/197 9 Cytoskeleton_Spindle microtubules 9.227e−4 11/109 10 Cell adhesion_Cell junctions 9.275e−4 14/162

TABLE 7D Enrichment by protein function - recurrence of triple-negative breast cancer Protein In function Protein In data protein in class Actual n R N Expected Ratio p-value z-score set function database Ligands 26 382 514 23844 8.235 3.157 2.918E−07 6.309 6.81% 5.06% 2.16% Phosphatases 8 382 230 23844 3.685 2.171 3.259E−02 2.277 2.09% 3.48% 0.96% Proteases 17 382 559 23844 8.956 1.898 9.214E−03 2.742 4.45% 3.04% 2.34% Enzymes 80 382 2724 23844 43.64 1.833 5.155E−08 5.895 20.94% 2.94% 11.42% Kinases 12 382 654 23844 10.48 1.145 3.572E−01 0.4808 3.14% 1.83% 2.74% Receptors 22 382 1565 23844 25.07 0.8775 3.034E−01 −0.6399 5.76% 1.41% 6.56% Transcription 3 382 959 23844 15.36 0.1953 1.170E−04 −3.246 0.79% 0.31% 4.02% factors Other 215 382 16691 23844 267.4 0.804 7.684E−09 −5.898 56.28% 1.29% 70.00%

For the “no relapse” group, 189 proteins were significantly differentially expressed: 98 were overexpressed and 91 were underexpressed (Table 8A). For this group, the best score for the Process Network was obtained for “Cell adhesion_Integrin-mediated cell-matrix adhesion” (p=7.5 10⁻¹¹) (Table 8C). The protein class “ligands” was found to have to best z-score in the module “Enrichment for Protein Function” with 15 proteins (Table 8D).

TABLE 8A Proteins underexpressed and overexpressed in non-recurrence of triple- negative breast cancer Confidence intervals Peptide Gene Protein Mean min max number APOD Apolipoprotein D 0.049 0.03 0.08 10 PIP Prolactin-inducible protein 0.069 0.016 0.224 5 IGHA2 Ig alpha-2 chain C region 0.07 0.044 0.112 8 COL1A1 Collagen alpha-1(I) chain 0.087 0.054 0.128 21 IGJ Immunoglobulin J chain 0.087 0.037 0.201 2 AZGP1 Zinc-alpha-2-glycoprotein 0.1 0.068 0.147 15 DCN Decorin 0.155 0.096 0.269 19 OGN Mimecan 0.16 0.118 0.214 11 TF Serotransferrin 0.165 0.132 0.206 41 LTF Lactotransferrin 0.18 0.088 0.373 36 COL6A6 Collagen alpha-6(VI) chain 0.187 0.078 0.42 3 HMGCS2 Hydroxymethylglutaryl-CoA synthase. mitochondrial 0.215 0.119 0.391 4 DES Desmin 0.22 0.111 0.428 2 ADH1C Alcohol dehydrogenase 1C 0.299 0.12 0.681 2 AKR1C1 Aldo-keto reductase family 1 member C1 0.306 0.164 0.565 2 TTR Transthyretin 0.327 0.222 0.484 6 DPT Dermatopontin 0.333 0.2 0.562 4 OLFML3 Olfactomedin-like protein 3 0.35 0.197 0.617 4 DHRS2 Dehydrogenase/reductase SDR family member 2 0.353 0.186 0.668 7 HIST3H2A Histone H2A type 3 0.359 0.242 0.529 2 PLIN1 Perilipin-1 0.361 0.217 0.585 7 CLEC3B Tetranectin 0.38 0.173 0.804 2 BCCIP BRCA2 and CDKN1A-interacting protein 0.381 0.209 0.678 2 IGHG1 Ig gamma-1 chain C region 0.398 0.275 0.571 12 LBP Lipopolysaccharide-binding protein 0.407 0.24 0.686 3 HPGD 15-hydroxyprostaglandin dehydrogenase [NAD+] 0.41 0.251 0.654 5 OAT Ornithine aminotransferase. mitochondrial 0.416 0.301 0.565 20 CFD Complement factor D 0.417 0.218 0.781 2 HP Haptoglobin 0.421 0.302 0.58 13 HPX Hemopexin 0.421 0.214 0.912 16 GC Vitamin D-binding protein 0.423 0.291 0.605 9 LRG1 Leucine-rich alpha-2-glycoprotein 0.426 0.247 0.723 3 SERPINA4 Kallistatin 0.435 0.234 0.792 4 AOC3 Membrane primary amine oxidase 0.436 0.3 0.633 10 APOA4 Apolipoprotein A-IV 0.438 0.256 0.754 6 PTRF Polymerase I and transcript release factor 0.443 0.26 0.738 5 ALOX15B Arachidonate 15-lipoxygenase B 0.448 0.285 0.702 10 MYH11 Myosin-11 0.457 0.343 0.61 13 MFAP4 Microfibril-associated glycoprotein 4 0.459 0.259 0.807 2 ORM1 Alpha-1-acid glycoprotein 1 0.46 0.26 0.8 4 IDI1 Isopentenyl-diphosphate Delta-isomerase 1 0.463 0.263 0.798 5 SFRP1 Secreted frizzled-related protein 1 0.464 0.311 0.699 3 NA Ig kappa chain V-II region GM607 (Fragment) 0.465 0.267 0.803 2 MCCC1 Methylcrotonoyl-CoA carboxylase subunit alpha. 0.465 0.228 0.917 2 mitochondrial CP Ceruloplasmin 0.467 0.349 0.624 11 CYP2A6 Cytochrome P450 2A6 0.469 0.3 0.726 7 AHSG Alpha-2-HS-glycoprotein 0.471 0.191 0.997 4 AACS Acetoacetyl-CoA synthetase 0.474 0.235 0.916 2 AMBP Protein AMBP 0.475 0.334 0.674 5 CMA1 Chymase 0.48 0.344 0.679 6 IGLC6 Ig lambda-6 chain C region 0.482 0.333 0.697 2 MCCC2 Methylcrotonoyl-CoA carboxylase beta chain. 0.482 0.322 0.712 11 mitochondrial BGN Biglycan 0.483 0.365 0.631 19 UROS Uroporphyrinogen-III synthase 0.483 0.281 0.808 3 AKR1B15 Putative aldo-keto reductase family 1 member B15 0.487 0.308 0.773 3 HAAO 3-hydroxyanthranilate 3.4-dioxygenase 0.496 0.287 0.846 2 ASPN Asporin 0.497 0.364 0.672 15 IGHM Ig mu chain C region 0.498 0.369 0.682 15 PIGR Polymeric immunoglobulin receptor 0.505 0.307 0.81 5 HBA1 Hemoglobin subunit alpha 0.51 0.29 0.881 10 F2 Prothrombin 0.516 0.397 0.673 14 TNXB Tenascin-X 0.519 0.309 0.897 6 SDCBP Syntenin-1 0.522 0.337 0.812 5 ACSS3 Acyl-CoA synthetase short-chain family member 3. 0.526 0.285 0.961 2 mitochondrial LPP Lipoma-preferred partner 0.529 0.355 0.787 10 SOD3 Extracellular superoxide dismutase [Cu—Zn] 0.54 0.314 0.886 3 OPLAH 5-oxoprolinase 0.546 0.332 0.923 13 DNAJA3 DnaJ homolog subfamily A member 3. 0.548 0.325 0.908 4 mitochondrial APOH Beta-2-glycoprotein 1 0.555 0.323 0.948 5 PCOLCE Procollagen C-endopeptidase enhancer 1 0.556 0.36 0.848 6 ALDH6A1 Methylmalonate-semialdehyde dehydrogenase 0.559 0.356 0.862 7 [acylating]. mitochondrial SLC9A3R1 Na(+)/H(+) exchange regulatory cofactor NHE-RF1 0.567 0.368 0.865 4 TWF1 Twinfilin-1 0.579 0.375 0.886 4 CTBP2 C-terminal-binding protein 2 0.589 0.362 0.954 3 CYB5A Cytochrome b5 0.594 0.397 0.879 4 AHNAK Neuroblast differentiation-associated protein 0.597 0.48 0.739 61 AHNAK PLG Plasminogen 0.6 0.409 0.875 12 CLU Clusterin 0.605 0.384 0.973 8 ERLIN2 Erlin-2 0.607 0.385 0.952 4 EFEMP1 EGF-containing fibulin-like extracellular matrix 0.608 0.391 0.937 3 protein 1 ERLIN2 Erlin-2 0.609 0.383 0.959 4 KRT1 Keratin. type II cytoskeletal 1 0.612 0.408 0.955 13 SERPING1 Plasma protease C1 inhibitor 0.616 0.397 0.961 6 HIST1H2AC Histone H2A type 1-C 0.619 0.415 0.926 2 ASS1 Argininosuccinate synthase 0.619 0.388 0.981 4 HIST2H2AC Histone H2A type 2-C 0.62 0.429 0.898 4 SCP2 Non-specific lipid-transfer protein 0.643 0.467 0.888 10 HIST1H2BK Histone H2B type 1-K 0.646 0.466 0.874 6 MGST1 Microsomal glutathione S-transferase 1 0.648 0.421 0.999 4 C4BPA C4b-binding protein alpha chain 0.669 0.448 0.997 4 SELENBP1 Selenium-binding protein 1 0.765 0.6 0.976 11 ADAR Double-stranded RNA-specific adenosine 1.324 1.002 1.738 11 deaminase CHD4 Chromodomain-helicase-DNA-binding protein 4 1.344 1.029 1.757 11 SAMHD1 SAM domain and HD domain-containing protein 1 1.347 1.055 1.713 13 PSME1 Proteasome activator complex subunit 1 1.347 1.022 1.786 9 NONO Non-POU domain-containing octamer-binding 1.366 1.073 1.731 19 protein DDX5 Probable ATP-dependent RNA helicase DDX5 1.372 1 1.864 7 NCL Nucleolin 1.376 1.019 1.891 19 GRB2 Growth factor receptor-bound protein 2 1.409 1.036 1.941 8 CCT2 T-complex protein 1 subunit beta 1.416 1.064 1.877 13 HNRNPA2B1 Heterogeneous nuclear ribonucleoproteins A2/B1 1.441 1.024 2.14 21 FBL rRNA 2′-O-methyltransferase fibrillarin 1.444 1.047 1.99 9 PRKAR2A cAMP-dependent protein kinase type II-alpha 1.445 1.043 2.019 6 regulatory subunit TRIM28 Transcription intermediary factor 1-beta 1.449 1.13 1.857 17 DYNLL1 Dynein light chain 1. cytoplasmic 1.46 1.042 2.066 4 HK1 Hexokinase-1 1.463 1.002 2.228 12 DNM2 Dynamin-2 1.481 1.071 2.035 9 STIP1 Stress-induced-phosphoprotein 1 1.49 1.076 2.102 11 S100A8 Protein S100-A8 1.5 1.106 2.024 9 SNRPB Small nuclear ribonucleoprotein-associated proteins 1.505 1.071 2.146 10 B and B′ EZR Ezrin 1.522 1.05 2.208 9 P4HB Protein disulfide-isomerase 1.522 1.033 2.274 28 ATP6V1A V-type proton ATPase catalytic subunit A 1.529 1.073 2.203 9 HSP90B1 Endoplasmin 1.53 1.212 1.954 32 CALR Calreticulin 1.533 1.168 2.03 18 HSP90B1 Endoplasmin 1.537 1.213 1.979 32 PAICS Multifunctional protein ADE2 1.538 1.108 2.14 10 MAP2K2 Dual specificity mitogen-activated protein kinase 1.539 1.031 2.33 2 kinase 2 H2AFY Core histone macro-H2A.1 1.542 1.078 2.199 10 DEK Protein DEK 1.545 1.13 2.127 8 SET Protein SET 1.55 1.099 2.189 6 ACTR3 Actin-related protein 3 1.552 1.129 2.13 12 ACTG1 Actin. cytoplasmic 2 1.559 1.103 2.197 6 GAA Lysosomal alpha-glucosidase 1.568 1.078 2.297 10 LCP1 Plastin-2 1.569 1.126 2.193 20 XRCC5 X-ray repair cross-complementing protein 5 1.583 1.103 2.286 16 SSRP1 FACT complex subunit SSRP1 1.588 1.067 2.356 8 KRT14 Keratin. type I cytoskeletal 14 1.588 1.011 2.549 5 HSPE1 10 kDa heat shock protein. mitochondrial 1.591 1.083 2.363 6 TNC Tenascin 1.609 1.114 2.496 38 EIF2S3 Eukaryotic translation initiation factor 2 subunit 3 1.61 1.127 2.307 3 WARS Tryptophanyl-tRNA synthetase. cytoplasmic 1.615 1.001 2.598 9 HSPA5 78 kDa glucose-regulated protein 1.623 1.177 2.298 30 SSR1 Translocon-associated protein subunit alpha 1.626 1.016 2.583 3 CAMK2D Calcium/calmodulin-dependent protein kinase type 1.631 1.07 2.574 3 II subunit delta PPIA Peptidyl-prolyl cis-trans isomerase A 1.633 1.012 2.56 14 MRPL19 39S ribosomal protein L19. mitochondrial 1.635 1.087 2.459 4 ERH Enhancer of rudimentary homolog 1.642 1.01 2.699 2 CALU Calumenin 1.649 1.133 2.418 7 LRRC59 Leucine-rich repeat-containing protein 59 1.656 1.14 2.419 7 ERH Enhancer of rudimentary homolog 1.657 1.017 2.724 2 PAPSS1 Bifunctional 3′-phosphoadenosine 5′- 1.677 1.113 2.551 13 phosphosulfate synthase 1 CFL1 Cofilin-1 1.681 1.054 2.543 17 MSN Moesin 1.695 1.349 2.133 32 ISYNA1 Inositol-3-phosphate synthase 1 1.698 1.016 2.853 3 RBMX Heterogeneous nuclear ribonucleoprotein G 1.706 1.08 2.706 6 MAT2B Methionine adenosyltransferase 2 subunit beta 1.711 1.002 2.923 3 AKR7A3 Aflatoxin B1 aldehyde reductase member 3 1.711 1 2.994 2 RAN GTP-binding nuclear protein Ran 1.722 1.3 2.29 9 ARF1 ADP-ribosylation factor 1 1.722 1.176 2.553 5 NME2 Nucleoside diphosphate kinase B 1.725 1.191 2.515 9 RPS27A Ubiquitin-40S ribosomal protein S27a 1.733 1.192 2.533 4 TUBB Tubulin beta chain 1.758 1.118 2.706 15 SLC2A1 Solute carrier family 2. facilitated glucose 1.782 1.081 3.003 3 transporter member 1 SMARCA5 SWI/SNF-related matrix-associated actin- 1.796 1.164 2.832 4 dependent regulator of chromatin subfamily A member 5 YBX1 Nuclease-sensitive element-binding protein 1 1.797 1.176 2.765 6 PAK2 Serine/threonine-protein kinase PAK 2 1.804 1.079 3.009 2 CTNNBL1 Beta-catenin-like protein 1 1.834 1.054 3.211 4 MACF1 Microtubule-actin cross-linking factor 1. isoforms 1.838 1.109 3.039 3 1/2/3/5 USP15 Ubiquitin carboxyl-terminal hydrolase 15 1.853 1.263 2.737 4 RPS9 40S ribosomal protein S9 1.862 1.195 3.145 14 AP1B1 AP-1 complex subunit beta-1 1.877 1.2 2.947 10 CPNE3 Copine-3 1.914 1.221 3.052 4 EIF4A1 Eukaryotic initiation factor 4A-I 1.921 1.446 2.559 13 EIF4A1 Eukaryotic initiation factor 4A-I 1.927 1.457 2.614 13 TUBA1B Tubulin alpha-1B chain 1.929 1.063 3.529 2 CPNE1 Copine-1 1.932 1.214 3.123 4 MYL12B Myosin regulatory light chain 12B 1.943 1.43 2.651 7 MAN2B1 Lysosomal alpha-mannosidase 1.952 1.22 3.123 5 MAPRE1 Microtubule-associated protein RP/EB family 1.973 1.217 3.188 3 member 1 CSDE1 Cold shock domain-containing protein E1 1.975 1.057 3.613 4 SOD2 Superoxide dismutase [Mn]. mitochondrial 1.991 1.332 2.986 5 GSTM1 Glutathione S-transferase Mu 1 1.993 1.1 3.682 2 MRPL9 39S ribosomal protein L9. mitochondrial 1.994 1.163 3.469 3 AARS Alanyl-tRNA synthetase. cytoplasmic 2.001 1.33 3.056 9 KRT6A Keratin. type II cytoskeletal 6A 2.004 1.09 3.811 3 KRT15 Keratin. type I cytoskeletal 15 2.049 1.271 3.401 8 KDM1A Lysine-specific histone demethylase 1A 2.069 1.065 3.93 2 LSP1 Lymphocyte-specific protein 1 2.077 1.047 4.086 2 TPM1 Tropomyosin alpha-1 chain 2.089 1.296 3.316 12 NME1 Nucleoside diphosphate kinase A 2.162 1.395 3.349 4 ACTN4 Alpha-actinin-4 2.47 1.088 4.765 22 AP1M1 AP-1 complex subunit mu-1 2.492 1.437 4.336 3 EEF1A1 Elongation factor 1-alpha 1 2.508 1.538 4.473 11 ACP2 Lysosomal acid phosphatase 2.543 1.451 4.436 3 ITGAM Integrin alpha-M 2.555 1.486 4.406 3 MAPK13 Mitogen-activated protein kinase 13 2.761 1.514 5.106 2 SSB Lupus La protein 2.884 1.705 4.803 5 AGR2 Anterior gradient protein 2 homolog 6.456 3.28 12.577 3

TABLE 8B Gene Ontology (GO) molecular function - non-recurrence of triple-negative breast cancer Molecular functions pValue Ratio 1 protein binding 1.134e−22 168/8829 2 binding 1.241e−21  210/13778 3 small molecule binding 5.986e−10  65/2773 4 nucleotide binding 2.893e−8  58/2573 5 nucleoside phosphate binding 2.933e−8  58/2574 6 oxidoreductase activity, acting on 3.779e−8 12/139 the CH—OH group of donors, NAD or NADP as acceptor 7 structural constituent of cytoskeleton 8.925e−8 10/96  8 oxidoreductase activity, acting on 1.177e−7 12/154 CH—OH group of donors 9 structural molecule activity 6.414e−7 24/699 10 catalytic activity 1.507e−6  99/6069 11 purine ribonucleotide binding 3.651e−6  44/1995 12 ribonucleotide binding 3.699e−6  44/1996 13 aldo-keto reductase (NADP) activity 4.047e−6 05/23  14 alditol:NADP+ 1-oxidoreductase activity 4.128e−6 04/11  15 purine nucleotide binding 4.489e−6  44/2011 16 purine ribonucleoside triphosphate binding 5.512e−6  43/1960 17 cell surface binding 5.773e−6 07/64  18 identical protein binding 1.006e−5 27/992 19 enzyme binding 1.157e−5  32/1302 20 oxidoreductase activity 1.449e−5 24/839 21 actin binding 1.843e−5 15/381 22 alcohol dehydrogenase (NADP+) activity 2.182e−5 04/16  23 cytoskeletal protein binding 2.724e−5 21/703 24 receptor binding 3.475e−5  34/1506 25 heterocyclic compound binding 3.705e−5  92/5912 26 organic cyclic compound binding 3.731e−5  92/5913 27 adenyl ribonucleotide binding 6.522e−5  35/1621 28 serine-type endopeptidase activity 7.581e−5 10/203 29 adenyl nucleotide binding 7.650e−5  35/1634 30 ATP binding 1.038e−4  34/1592 31 methylcrotonoyl-CoA carboxylase activity 1.162e−4 02/02  32 androsterone dehydrogenase (B-specific) 1.162e−4 02/02  activity 33 glycosaminoglycan binding 1.173e−4 10/214 34 unfolded protein binding 1.445e−4  8/140 35 carbohydrate binding 1.586e−4 16/514 36 serine-type peptidase activity 2.261e−4 10/232 37 serine hydrolase activity 2.507e−4 10/235 38 hydrolase activity 2.554e−4 48/2676 39 polysaccharide binding 2.868e−4 10/239 40 pattern binding 2.868e−4 10/239 41 chaperone binding 3.159e−4 05/55  42 nucleoside-triphosphatase activity 3.259e−4 21/840 43 actin filament binding 4.356e−4 06/90  44 heparin binding 4.590e−4  8/166 45 pyrophosphatase activity 5.807e−4 21/878 46 hydrolase activity, acting on acid 6.067e−4 21/881 anhydrides, in phosphorus-containing anhydrides 47 hydrolase activity, acting on acid 6.246e−4 21/883 anhydrides 48 complement binding 6.284e−4 03/16  49 ketosteroid monooxygenase activity 6.876e−4 02/04  50 17-alpha,20-alpha-dihydroxypregn-4-en- 6.876e−4 02/04  3-one dehydrogenase activity

TABLE 8C Gene Ontology (GO) process - non-recurrence of triple-negative breast cancer Process networks pValue Ratio 1 Cell adhesion_Integrin-mediated 7.479e−11 24/214 cell-matrix adhesion 2 Cytoskeleton_Intermediate filaments 3.098e−9 14/81  3 Cytoskeleton_Regulation of cytoskeleton 5.148e−9 20/183 rearrangement 4 Cytoskeleton_Actin filaments 4.775e−7 17/176 5 Immune response_Phagosome in antigen 2.548e−6 19/243 presentation 6 Immune response_Phagocytosis 1.175e−5 17/222 7 Inflammation_Amphoterin signaling 7.625e−5 11/118 8 Cell cycle_Mitosis 2.233e−4 13/179 9 Inflammation_Kallikrein-kinin system 3.088e−4 13/185 10 Inflammation_IL-6 signaling 3.807e−4 10/119

TABLE 8D Enrichment by protein function - non-recurrence of triple-negative breast cancer Percentage Protein In In function Protein data protein in class Actual n R N Expected Ratio p-value z-score set function database Ligands 15 235 514 23844 5.066 2.961 1.925E−04 4.484 6.38% 2.92% 2.16% Enzymes 49 235 2724 23844 26.85 1.825 2.103E−05 4.565 20.85% 1.80% 11.42% Kinases 10 235 654 23844 6.446 1.551 1.139E−01 1.427 4.26% 1.53% 2.74% Phosphatases 3 235 230 23844 2.267 1.323 3.958E−01 0.4918 1.28% 1.30% 0.96% Proteases 7 235 559 23844 5.509 1.271 3.141E−01 0.6458 2.98% 1.25% 2.34% Receptors 5 235 1565 23844 15.42 0.3242 1.553E−03 −2.759 2.13% 0.32% 6.56% Transcription 3 235 959 23844 9.452 0.3174 1.365E−02 −2.153 1.28% 0.31% 4.02% factors Other 143 235 16691 23844 164.5 0.8693 1.631E−03 −3.076 60.85% 0.86% 70.00%

2.3. Classification Based on Relapse Status

The inventors investigated if they could detect differences between “relapse” and “no relapse” groups in terms of protein levels in the triple-negative tumors by OPLS analysis. This analysis was performed on 549 proteins for which quantitative informative was available in all the tumors. The OPLS model, initially based on all 549 proteins, was optimized by stepwise removal of proteins with small VIP (Variable Importance in the Projection) value. This was performed until the model did not improve anymore as judged by the CV-ANOVA p-value, indicative of the probability that the model is the result of chance alone. The optimized OPLS model included 58 proteins (p=2.1 10⁻¹⁵) (FIG. 2). Among these proteins, 33 were assigned to the group without recurrence and 26 to the group with recurrence. These proteins were matched against a database consisting of known protein signaling pathways using Metacore. For the “No-Relapse” group, 2 significant pathways (p<0.05) were found: Blood coagulation (p=4.4 10⁻⁶) and Chemotaxis_Lipoxin inhibitory action on fMLP-induced neutrophil chemotaxis (p=0.0003). The Relapse group was characterized by just one significant pathway: Cytoskeleton remodeling_Keratin filaments (p=7.9 10⁻⁷) (Table 9).

TABLE 9 Maps pValue Ratio No 1 Blood coagulation_Blood 4.471E−06 4 39 relapse coagulation 2 Chemotaxis_Lipoxin inhibitory 3.141E−04 3 46 action on fMLP-induced neutrophil chemotaxis relapse 1 Cytoskeleton remodeling_Keratin 7.957E−07 4 36 filaments

2.4. Proteomic Signature of “Relapse” Group Triple-Negative Breast Tumors

By combining protein lists obtained from the univariate (with iQuantitator) and the multivariate analyses (OPLS), two lists of proteins were generated that characterized the “Relapse” (9 proteins) and “No Relapse” (5 proteins) groups of triple negative breast tumors (Tables 10A and B). It is not possible to assign a significant pathway for the “No-Relapse” group with a FDR<0.05; on the other side, the pathway Cytoskeleton remodeling_Keratin filaments (p=1.9 10⁻⁸) was found for the “Relapse” group, according our previous analyses for this group. Among these proteins, Thrombospondin-1 is known to be a secreted ligand. While the Desmoplakin is a plasma membrane protein, it has already been described as a protein detectable in serum (López-Farré A. J. et al, 2012).

TABLE 10A Proteins characterizing the “no relapse” for triple-negative breast cancer Biomarkers for iTRAQ TNBC no Relapse GO uniprot expression ratio WARS Tryptophanyl- mitochondria over-expressed 1.6 tRNA synthetase SAMHD1 SAM domain and nucleus over-expressed 1.4 HD domain- containing protein 1 HSPE1 10 kDa heat mitochondria over-expressed 1.6 shock protein IGHG1 Ig gamma-1 chain secreted under-expressed 0.4 C region HK1 Hexokinase-1 cytosol over-expressed 1.5

TABLE 10B Proteins characterizing the “relapse” for triple-negative breast cancer iTRAQ Biomarkers for TNBC Relapse GO uniprot expression ratio DSP Desmoplakin plasma over-expressed 1.8 membrane ARHGAP1 Rho GTPase- cytosol over-expressed 1.3 activating protein 1 EPPK1 Epiplakin cytoplasm over-expressed 1.4 KRT19 Keratin type I cell over-expressed 2.1 cytoskeletal 19 periphery THBS1 Thrombos- secreted over-expressed 1.7 pondin-1 KRT8 Keratin type II keratin over-expressed 2.7 cytoskeletal 8 filament IDH2 Isocitrate mitochondria over-expressed 1.7 dehydrogenase [NADP] G6PD Glucose-6- cytoplasm over-expressed 1.7 phosphate 1-dehydro-genase DPYSL3 Dihydro- cytoplasm over-expressed 1.9 pyrimidinase- related protein 3

2.5. Pathways Analysis of Individual Tumor

Pathway analysis was also performed on each of the 80 tumor samples separately. By this, the inventors obtained a fingerprint of affected pathways for each tumor. All proteins with a level significantly differing from the mean protein level among all “Relapse group” tumors or “No-relapse group” tumors were included in the individual tumor analysis; in total 1078 proteins. The relative intensities of these tumor specific proteins were mapped to the pathway maps of the Metacore database. The analysis identified the pathways that were the most significant in each of the 80 individual tumors data sets, measured by Fisher's exact test. The inventors used the association ranks as input variables to the multivariate analysis for sample comparison, thus based on pathway enrichment. To detect pathway alterations connected to relapse risk, the inventors performed OLPLS analysis on the pathway association data. The OPLS model was optimized as described in the group analysis. The inventors performed stepwise removal of variables (i.e. pathways) with less influence on the separation performance of the model until the model did not improve anymore. The most significant pathway for “No-relapse group” is Glycolysis. The top-ranked pathways in relapse group were cytoskeleton Remodeling_Keratins-filaments and Gap junctions.

2.6. Validation of Dysregulated Protein Expression

To proceed with the first steps in validating our MS analysis, the inventors confirmed the differential expression of two dysregulated proteins by Western-Blot analysis using samples from the same triple-negative breast tumors cohort. The proteins Thrombospondin-1 and Tryptophanyl-tRNA synthetase were selected for validation based on their potential significance in breast cancer tumorigenesis. The expression of Thrombospondin-1 was found to be elevated in primary breast tumors of the “recurrent” group when compared to the “non-recurrent” group tumors. Inversely, Tryptophanyl-tRNA synthetase was found to be elevated in the “No Relapse” group when compared to the “Relapse” group (FIG. 3).

2.7. Pronostic Value of the Markers

The prognostic value of the markers was evaluated through estimation of overall survival (OS) using Kaplan-Meier method. The patients were divided into two categories based on the median iTraq expression data for each marker: high versus low expression.

For the “No relapse” group, patients' tumor with high expression levels of Tryptophanyl-tRNA synthetase (WARS), 10 kDa heat shock protein (HSPE1), SAM domain and HD domain-containing protein 1 (SAMHD1) and Hexokinase-1 (HK1) experienced a significantly better DFS (Disease Free Survival) compared with those with low expression (p=0.0017, p=0.0042, p=0.0073, p=0.0124 respectively), and inversely, patients' tumor with low expression levels of Ig gamma-1 chain C region (IGHG1) showed a significant better DFS compared with those with high expression (p=0.0339), in agreement with iTraq results (FIG. 4). Furthermore, tumors with high Tryptophanyl-tRNA synthetase (WARS)(p=0.0026), 10 kDa heat shock protein (HSPE1) (p=0.0067) and Ig gamma-1 chain C region (IGHGI) (p=0.031) expression were also associated with higher OS (overall survival) rates (FIG. 5).

For the “Relapse” group, patients' tumors with high expression level of any of the 9 proteins experienced a significantly worse DFS compared with those with low expression (p<0.0001, p=0.0001, p=0.0005, p<0.0001, p=0.021, p=0.0051, p=0.020, p=0.0457 and p=0.031) for pourquoi Desmoplakin (DSP), Thrombospondin-1 (THBS1), Glucose-6-phosphate 1-dehydrogenase (G6PD), Isocitrate dehydrogenase [NADP] (IDH2), Keratin type I cytoskeletal 19 (KRT19), Keratin type II cytoskeletal 8 (KRT8), Epiplakin (EPPK1), Rho GTPase-activating protein 1 (ARHGAP1), and Dihydropyrimidinase-related protein 3 (DPYSL3), respectively (FIG. 6). Furthermore, tumors with high Desmoplakin (DSP) (p=0.001), Thrombospondin-1 (THSB1) (p=0.0001), Glucose-6-phosphate 1-dehydrogenase (G6PD) (p=0.0014) and Isocitrate dehydrogenase [NADP] (IDH2) (p=0.0005) expression were also associated with lower OS rates (FIG. 7). Accordingly, the respective hazard ratios for disease progression or death were also significantly higher for patients whose tumors had high expression of these proteins. Specifically, elevated Thrombospondin-1 (THSB1) (HR=3.91−HR: Hazard rate ratio) Desmoplakin (DSP) (HR=4.36), Glucose-6-phosphate 1-dehydrogenase (G6PD) (HR=4.18), Isocitrate dehydrogenase [NADP] (IDH2) (HR=4.42), Keratin type I cytoskeletal 19 (KRT19) (HR=2.97), Keratin type II cytoskeletal 8 (KRT8) (HR=2.70), Epiplakin (EPPK1) (HR=2.47), Rho GTPase-activating protein 1 (ARHGAP1) (HR=5.06) or Dihydropyrimidinase-related protein 3 (DPYSL3) (HR=2.98) were associated with increased risk of disease progression. Similar association were observed for increased risk of death for Thrombospondin-1 (THSB1) (HR=4.30), Desmoplakin (DSP) (HR=3.67), Glucose-6-phosphate 1-dehydrogenase (G6PD) (HR=3.90), Isocitrate dehydrogenase [NADP] (IDH2) (HR=3.32), or Keratin type II cytoskeletal 8 (KRT8) (HR=2.50). In opposition, the hazard ratios for non-recurrent group were significantly higher for patients whose tumors had high expression of Tryptophanyl-tRNA synthetase (WARS), 10 kDa heat shock protein (HSPE1), SAM domain and HD domain-containing protein 1 (SAMHD1), Hexokinase-1 (HK1) and a low expression of Ig gamma-1 chain C region (IGHG1). Specifically, elevated Tryptophanyl-tRNA synthetase (WARS)(HR=3.12) and 10 kDa heat shock protein (HSPE1) (3.67) were associated with a weak risk of disease progression or death.

The FIG. 8 summarizes these Kaplan-Meier curves for three secreted proteins: Desmoplakin (DSP), THSB1 and Ig gamma-1 chain C region (IGHG1).

2.8. Preliminary Validation in Patient-Derived Serum Samples

The inventors then questioned whether any of secreted protein could be measured in the serum of TNBC patients, notably in TNBC relapsing patients.

The determination of the amount of Desmoplakin in the serum of the TNBC cohort corresponding to the triple-negative tumors studied in this paper, showed that Desmoplakin is more concentrated in the “Relapse” group (p=0.01) than in the “No-Relapse” group, according to the proteomic results disclosed herein (FIG. 9).

As very little serum samples were available in this cohort, the inventors extended the determination of Desmoplakin expression in a newer TNBC serum cohort. Based on this new cohort, the inventors demonstrated a significant overexpressed amount of Desmoplakin in TNBC serums compared with healthy controls (p=0.0008).

3. Discussion

Despite the many recent advances in breast tumors treatments through targeted therapies, no specific treatment exists for the triple-negative breast tumors and there are no prognostic molecular markers that would predict whether a tumor will behave aggressively or remain indolent. It is abundantly clear that tumor biology plays a significant role in resultant tumor behaviour. Unfortunately, triple-negative breast primary tumors that are placed in the same prognostic category based on currently used parameters, may behave differently. It is the inventors' hypothesis that the underlying biology of these tumors and differences in its detail will determine a particular tumor's potential for aggressiveness. In addition, these biological differences can be used to identify novel molecular markers that may be useful for diagnostic, prognostic, or predictive purposes, the success of which would pave the road to a new era of personalized medicine in breast cancer.

In this study, the inventors performed quantitative proteomic profiling of 80 triple-negative breast tumors to identify first differential protein expression between triple-negative breast tumors and normal tissues and second, to identify potential prognostic markers of recurrence. To the inventors' knowledge, this study represents the largest proteomic analysis of triple-negative breast tumors ever realized.

From all the triple negative breast tumors, 219 proteins with significant differential expression in tumors compared to normal tissues were identified. Among these proteins, 58 proteins had previously been reported to be involved in breast tumors.

Another aim of this study was to identify differential protein expression between no relapse patients' group and relapse patients' group. The inventors characterized 5 proteins associated with the no-relapse group (i.e. Hexokinase-1, 10 kDa heat shock protein, Ig gamma-1 chain C region, SAM domain and HD domain-containing protein 1, and Tryptophanyl-tRNA synthetase) and 9 proteins associated with the relapse group (i.e. Desmoplakin, Rho GTPase-activating protein 1, Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Isocitrate dehydrogenase [NADP], Keratin type I cytoskeletal 19, Keratin type I cytoskeletal 8, Dihydropyrimidinase-related protein 3, and Thrombospondin-1). It is thus proposed herein that the above group of proteins is a protein signature of the no-relapse group and relapse group of triple negative breast tumors, respectively.

Among these proteins, it was shown that Desmoplakin could be easily detected in serum of patients, and was also differentially expressed in “Relapse” group compared to “No-Relapse” group. As previously mentioned, this protein is a key component of desmosomes, and belong to the pathway cytoskeleton Remodeling_Keratins-filaments and Gap junctions found in Metacore analysis, that is in agreement with the fact that this pathway is the top-ranked pathway characterizing the “Relapse” group in our proteomic approach. Expanding the assays on a larger cohort sera of patients with breast cancer, the inventors demonstrated that this protein is differentially over-expressed in TNBC sera compared to healthy controls.

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The invention claimed is:
 1. An in vitro method for diagnosing and/or prognosing and treating a recurrent triple-negative breast cancer in a subject, comprising the steps of: a) obtaining a biological sample from a subject, b) detecting the expression levels of three biomarkers comprising Desmoplakin, Thrombospondin-1 and Isocitrate dehydrogenase [NADP] in the biological sample, c) diagnosing and/or prognosing a recurrent triple-negative breast cancer when the expression levels of the three biomarkers comprising Desmoplakin, Thrombospondin-1 and Isocitrate dehydrogenase [NADP] are superior to the expression levels of the three biomarkers comprising Desmoplakin, Thrombospondin-1 and Isocitrate dehydrogenase [NADP] in a biological sample of at least one healthy subject, and d) administering an effective amount of a chemotherapeutic agent to the diagnosed subject.
 2. The method according to claim 1, further comprising detecting the expression levels of at least two biomarkers selected from the group consisting of Hexokinase-1, 10 kDa heat shock protein, Ig gamma-1 chain C region, SAM domain and HD domain-containing protein 1, and Tryptophanyl-tRNA synthetase in the biological sample in step b).
 3. The method according to claim 2, wherein the expression level of Hexokinase-1, 10 kDa heat shock protein, SAM domain and HD domain-containing protein 1, or Tryptophanyl-tRNA synthetase, is superior to a reference expression level obtained from a biological sample of at least one healthy subject.
 4. The method according to claim 2, wherein the expression level of Ig gamma-1 chain C region is inferior to a reference expression level obtained from a biological sample of at least one healthy subject.
 5. The method according to claim 2, wherein one of said at least two biomarkers is Tryptophanyl-tRNA synthetase.
 6. The method according to claim 1, further comprising detecting the expression levels of at least one biomarker selected from the group consisting of Rho GTPase-activating protein 1, Epiplakin, Glucose-6-phosphate 1-dehydrogenase, Keratin type I cytoskeletal 19, Keratin type I cytoskeletal 8, and Dihydropyrimidinase-related protein 3 in the biological sample in step b).
 7. The method according to claim 1, further comprising measuring the expression level of the biomarkers Hexokinase-1, 10 kDa heat shock protein, SAM domain and HD domain-containing protein 1, and Tryptophanyl-tRNA synthetase, and Ig gamma-1 chain C region in the biological sample in step b).
 8. The method according to claim 1, further comprising detecting the expression level of biomarkers Glucose-6-phosphate 1-dehydrogenase in the biological sample in step b).
 9. The method according to claim 1, further comprising detecting the expression level of biomarkers Glucose-6-phosphate 1-dehydrogenase, and Keratin type II cytoskeletal 8 in the biological sample in step b).
 10. The method according to claim 1, wherein the expression level is determined by a method selected from the group consisting of Western blot, immunoblot, enzyme-linked immunosorbant assay (ELISA), enzyme-linked immunospot (ELISPOT), radioimmunoas say (RIA), immunohistochemistry, immunoprecipitation, fluorescence activated cell sorting (FACS), microscopy, flow cytometry, microcytometry, protein binding assay, ligand binding assay, microarray, polyacrylamide gel electrophoresis such as SDS-PAGE, surface plasmon resonance (SPR), Förster resonance energy transfer (FRET), Bioluminescence resonance energy transfer (BRET), chemiluminescence, fluorescent polarization, phosphorescence, mass spectrometry, magnetic resonance imaging (MRI), and any combination thereof. 